{"id":493,"date":"2021-09-28T00:02:01","date_gmt":"2021-09-28T04:02:01","guid":{"rendered":"https:\/\/www.jlhaddock.com\/?page_id=493"},"modified":"2023-01-05T15:37:16","modified_gmt":"2023-01-05T20:37:16","slug":"extended-bankruptcy-consultation-form","status":"publish","type":"page","link":"https:\/\/www.jlhaddock.com\/index.php\/extended-bankruptcy-consultation-form\/","title":{"rendered":"Extended Bankruptcy Consultation Form"},"content":{"rendered":"\n<p>Please complete this extended interactive form at your convenience. It is designed to only ask for information relevant to you based on your responses as you complete it. You will be able to fill out the form in sections, leaving and returning using the same device, <strong>but we will not receive any information you provide until you submit the completed form.<\/strong><\/p>\n\n\n\n<p>After submitting the free Extended Bankruptcy Consultation Form, you will receive an email confirming your submission. If you do not receive a response from an attorney within 24 hours, please <a href=\"https:\/\/www.jlhaddock.com\/wp-admin\/post.php?post=271&amp;action=edit\">contact us.<\/a><\/p>\n\n\n\n<p><em><strong>If the interactive bankruptcy evaluation form does not appear below, you can use a <a href=\"https:\/\/www.jlhaddock.com\/Forms\/General-information-form.pdf\">standard pdf version<\/a> of our Bankruptcy Consultation Form, instead.<\/strong> <\/em><\/p>\n\n\n\n<div class='fluentform ff-default fluentform_wrapper_8 ffs_default_wrap'><form data-form_id=\"8\" id=\"fluentform_8\" class=\"frm-fluent-form fluent_form_8 ff-el-form-top ff_form_instance_8_1 ff-form-loading ff-form-has-steps ffs_default\" data-form_instance=\"ff_form_instance_8_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Michigan Bankruptcy Free Extended Consultation Form<\/legend>        <div\n                style=\"display: none!important; position: absolute!important; transform: translateX(1000%)!important;\"\n                class=\"ff-el-group ff-hpsf-container\"\n        >\n            <div class=\"ff-el-input--label asterisk-right\">\n                <label for=\"ff_8_item_sf\" aria-label=\"Newsletter\">\n                    Newsletter                <\/label>\n            <\/div>\n            <div class=\"ff-el-input--content\">\n                <input type=\"text\"\n                       name=\"item_8__fluent_sf\"\n                       class=\"ff-el-form-control\"\n                       id=\"ff_8_item_sf\"\n                \/>\n            <\/div>\n        <\/div>\n                <input type=\"hidden\" id=\"__fluent_protection_token_8\" class=\"fluent-form-token-field\" name=\"__fluent_protection_token_8\">\n        <input type='hidden' name='__fluent_form_embded_post_id' value='493' \/><input type=\"hidden\" id=\"_fluentform_8_fluentformnonce\" name=\"_fluentform_8_fluentformnonce\" value=\"9b70de8c18\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/493\" \/><div class='ff-step-container' data-name=\"step_start-8_44\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"yes\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"steps\" ><div class='ff-step-header'><ul class='ff-step-titles'><li class=\"ff_active\"><span class=\"ff-step-title-text\">Contact and General Information<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Household Income<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Household Expenses<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Your Assets<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Your Debts<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Review customized Required Documents list<\/span><\/li><\/ul><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-8_44\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"yes\" data-enable_step_page_resume=\"yes\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"steps\" ><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_1\" ><h3 class='ff-el-section-title'>Contact and General Information<\/h3><div class='ff-section_break_desk'><p>This is an attempt to <strong>eliminate debt<\/strong> and any information obtained will be used for that purpose...<strong><em>if you would like our help with that sort of thing.\u00a0 <\/em>\ud83d\ude09<\/strong><\/p><\/div><hr \/><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_names_first_name_' id='label_ff_8_names_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_8_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" tabindex=\"1\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_names_middle_name_' id='label_ff_8_names_middle_name_' >Middle Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[middle_name]\" id=\"ff_8_names_middle_name_\" class=\"ff-el-form-control\" placeholder=\"Middle Name\" tabindex=\"2\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_names_last_name_' id='label_ff_8_names_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_8_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Last Name\" tabindex=\"3\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_email' id='label_ff_8_email' aria-label=\"Email Address\">Email Address<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_8_email\" class=\"ff-el-form-control\" placeholder=\"Email Address\" data-name=\"email\" tabindex=\"4\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_phone' id='label_ff_8_phone' aria-label=\"Primary Phone Number\">Primary Phone Number<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" placeholder=\"2485555555\" data-name=\"phone\" id=\"ff_8_phone\" tabindex=\"5\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_phone_1' id='label_ff_8_phone_1' aria-label=\"Secondary Phone Number\">Secondary Phone Number<\/label><\/div><div class='ff-el-input--content'><input name=\"phone_1\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" placeholder=\"3135555555\" data-name=\"phone_1\" id=\"ff_8_phone_1\" tabindex=\"6\" inputmode=\"tel\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address2\" ><div class='ff-el-input--label'><label aria-label=\"Address\">Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_address2_address_line_1_' id='label_ff_8_address2_address_line_1_' aria-label=\"Address Line 1\">Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address2[address_line_1]\" id=\"ff_8_address2_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\" tabindex=\"7\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address2_address_line_2_' id='label_ff_8_address2_address_line_2_' aria-label=\"Address Line 2\">Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address2[address_line_2]\" id=\"ff_8_address2_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Address Line 2\" data-key_name=\"address_line_2\" tabindex=\"8\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_address2_city_' id='label_ff_8_address2_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address2[city]\" id=\"ff_8_address2_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\" tabindex=\"9\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address2_state_' id='label_ff_8_address2_state_' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address2[state]\" id=\"ff_8_address2_state_\" class=\"ff-el-form-control\" placeholder=\"Michigan\" data-key_name=\"state\" tabindex=\"10\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_address2_zip_' id='label_ff_8_address2_zip_' aria-label=\"Zip Code\">Zip Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address2[zip]\" id=\"ff_8_address2_zip_\" class=\"ff-el-form-control\" placeholder=\"Zip Code\" data-key_name=\"zip\" tabindex=\"11\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_dropdown_12' id='label_ff_8_dropdown_12' aria-label=\"How long have you lived at this address?\">How long have you lived at this address?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_12\" id=\"ff_8_dropdown_12\" class=\"ff-el-form-control\" data-name=\"dropdown_12\" data-calc_value=\"0\" tabindex=\"12\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_8_dropdown_12\"><option value=\"\">- Select -<\/option><option value=\"Less than 6 months\"  selected>Less than 6 months<\/option><option value=\"6 months to 1 year\"  >6 months to 1 year<\/option><option value=\"1-2 years\"  >1-2 years<\/option><option value=\"2-3 years\"  >2-3 years<\/option><option value=\"3+ years\"  >3+ years<\/option><\/select><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address has-conditions\" data-type=\"address-element\" data-name=\"address3\" ><div class='ff-el-input--label'><label aria-label=\"What was your prior address?\">What was your prior address?<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address3_address_line_1_' id='label_ff_8_address3_address_line_1_' aria-label=\"Prior Address Line 1\">Prior Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address3[address_line_1]\" id=\"ff_8_address3_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Prior Address Line 1\" data-key_name=\"address_line_1\" tabindex=\"13\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address3_address_line_2_' id='label_ff_8_address3_address_line_2_' aria-label=\"Prior Address Line 2\">Prior Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address3[address_line_2]\" id=\"ff_8_address3_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Prior Address Line 2\" data-key_name=\"address_line_2\" tabindex=\"14\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address3_city_' id='label_ff_8_address3_city_' aria-label=\"Prior City\">Prior City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address3[city]\" id=\"ff_8_address3_city_\" class=\"ff-el-form-control\" placeholder=\"Prior City\" data-key_name=\"city\" tabindex=\"15\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address3_state_' id='label_ff_8_address3_state_' aria-label=\"Prior State\">Prior State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address3[state]\" value=\"Michigan\" id=\"ff_8_address3_state_\" class=\"ff-el-form-control\" placeholder=\"Prior State\" data-key_name=\"state\" tabindex=\"16\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address3_zip_' id='label_ff_8_address3_zip_' aria-label=\"Prior Zip Code\">Prior Zip Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address3[zip]\" id=\"ff_8_address3_zip_\" class=\"ff-el-form-control\" placeholder=\"Prior Zip Code\" data-key_name=\"zip\" tabindex=\"17\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_input_text_23' id='label_ff_8_input_text_23' aria-label=\"Date of Birth\">Date of Birth<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_23\" class=\"ff-el-form-control\" placeholder=\"12\/31\/1999\" data-name=\"input_text_23\" tabindex=\"18\" id=\"ff_8_input_text_23\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_dropdown' id='label_ff_8_dropdown' aria-label=\"How many people (other than yourself) are you financially responsible for?\">How many people (other than yourself) are you financially responsible for?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_8_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\" tabindex=\"19\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_8_dropdown\"><option value=\"\">- Select -<\/option><option value=\"None, it is just me\"  >None, it is just me<\/option><option value=\"1\"  >1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"4\"  >4<\/option><option value=\"5\"  >5<\/option><option value=\"6\"  >6<\/option><option value=\"More than 6\"  >More than 6<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Martial Status\">Martial Status<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_428dfb8c94dc3a73787e590dc80a6d3c'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"20\" value=\"Single\"  id='input_radio_428dfb8c94dc3a73787e590dc80a6d3c' aria-label='Single' aria-invalid='false' aria-required=true> <span>Single<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_d5e2216ab5a8c2b4f15b9035132b64c8'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Married\"  id='input_radio_d5e2216ab5a8c2b4f15b9035132b64c8' aria-label='Married' aria-invalid='false' aria-required=true> <span>Married<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_d8ad6b1064cbba26fbee0f28cf034dc2'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Married, but living separately\"  id='input_radio_d8ad6b1064cbba26fbee0f28cf034dc2' aria-label='Married, but living separately' aria-invalid='false' aria-required=true> <span>Married, but living separately<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9bbbf4b895d30c37f6deb89daf9eadae'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Divorced\"  id='input_radio_9bbbf4b895d30c37f6deb89daf9eadae' aria-label='Divorced' aria-invalid='false' aria-required=true> <span>Divorced<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_6ade59b4fb4e4e434f48ddaa12726cab'><input  type=\"radio\" name=\"input_radio\" data-name=\"input_radio\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Widowed\"  id='input_radio_6ade59b4fb4e4e434f48ddaa12726cab' aria-label='Widowed' aria-invalid='false' aria-required=true> <span>Widowed<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Was your Judgment of Divorce entered more than seven years ago?\">Was your Judgment of Divorce entered more than seven years ago?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_44_4e166dd475c70d83f85283e33c051790'><input  type=\"radio\" name=\"input_radio_44\" data-name=\"input_radio_44\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"21\" value=\"yes\"  id='input_radio_44_4e166dd475c70d83f85283e33c051790' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_44_1525bb2a898f0c8fc830be8a8e8edd74'><input  type=\"radio\" name=\"input_radio_44\" data-name=\"input_radio_44\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_44_1525bb2a898f0c8fc830be8a8e8edd74' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_1\" class=\"has-conditions  ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_names_1_first_name_' id='label_ff_8_names_1_first_name_' >Spouse's First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_8_names_1_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" tabindex=\"22\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_names_1_middle_name_' id='label_ff_8_names_1_middle_name_' >Spouse's Middle Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[middle_name]\" id=\"ff_8_names_1_middle_name_\" class=\"ff-el-form-control\" placeholder=\"Middle Name\" tabindex=\"23\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_names_1_last_name_' id='label_ff_8_names_1_last_name_' >Spouse's Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[last_name]\" id=\"ff_8_names_1_last_name_\" class=\"ff-el-form-control\" placeholder=\"Last Name\" tabindex=\"24\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_3 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_email_1' id='label_ff_8_email_1' aria-label=\"Spouse&#039;s Email Address\">Spouse's Email Address<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email_1\" id=\"ff_8_email_1\" class=\"ff-el-form-control\" placeholder=\"Email\" data-name=\"email_1\" tabindex=\"25\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_2' id='label_ff_8_numeric-field_2' aria-label=\"Spouse&#039;s Primary Phone\">Spouse's Primary Phone<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_2\" id=\"ff_8_numeric-field_2\" class=\"ff-el-form-control\" placeholder=\"5865555555\" data-name=\"numeric-field_2\" inputmode=\"numeric\" step=\"any\" tabindex=\"26\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_3' id='label_ff_8_numeric-field_3' aria-label=\"Spouse&#039;s Secondary Phone\">Spouse's Secondary Phone<\/label><\/div><div class='ff-el-input--content'><input type=\"number\" name=\"numeric-field_3\" id=\"ff_8_numeric-field_3\" class=\"ff-el-form-control\" placeholder=\"7345555555\" data-name=\"numeric-field_3\" inputmode=\"numeric\" step=\"any\" tabindex=\"27\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_4\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_30' id='label_ff_8_input_text_30' aria-label=\"Spouse&#039;s Date of Birth\">Spouse's Date of Birth<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_30\" class=\"ff-el-form-control\" placeholder=\"12\/31\/1997\" data-name=\"input_text_30\" tabindex=\"28\" id=\"ff_8_input_text_30\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><\/div><\/div><div data-name=\"ff_cn_id_5\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Please describe your living space:\">Please describe your living space:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_13_4b2b610040817d36747c98a39bfa5ca8'><input  type=\"radio\" name=\"input_radio_13\" data-name=\"input_radio_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"29\" value=\"I own my living space\"  id='input_radio_13_4b2b610040817d36747c98a39bfa5ca8' aria-label='I own my living space' aria-invalid='false' aria-required=true> <span>I own my living space<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_13_8d9336b0bb5572208d9a3c4756017145'><input  type=\"radio\" name=\"input_radio_13\" data-name=\"input_radio_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"I rent my living space\"  id='input_radio_13_8d9336b0bb5572208d9a3c4756017145' aria-label='I rent my living space' aria-invalid='false' aria-required=true> <span>I rent my living space<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_13_5cedf53c2cd9fdf877f7b139c8a74d11'><input  type=\"radio\" name=\"input_radio_13\" data-name=\"input_radio_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"I live with friends or family\"  id='input_radio_13_5cedf53c2cd9fdf877f7b139c8a74d11' aria-label='I live with friends or family' aria-invalid='false' aria-required=true> <span>I live with friends or family<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_13_9c83b578d61002ef359f95ce9acdaf6f'><input  type=\"radio\" name=\"input_radio_13\" data-name=\"input_radio_13\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Other\"  id='input_radio_13_9c83b578d61002ef359f95ce9acdaf6f' aria-label='Other' aria-invalid='false' aria-required=true> <span>Other<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you own any other real estate or mobile homes?\">Do you own any other real estate or mobile homes?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_15_20417c3b261d88632a54b52d403e06aa'><input  type=\"radio\" name=\"input_radio_15\" data-name=\"input_radio_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"30\" value=\"yes\"  id='input_radio_15_20417c3b261d88632a54b52d403e06aa' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_15_0d52473521b3aa17855d62fe1c3dfccb'><input  type=\"radio\" name=\"input_radio_15\" data-name=\"input_radio_15\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"No\"  id='input_radio_15_0d52473521b3aa17855d62fe1c3dfccb' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_dropdown_1' id='label_ff_8_dropdown_1' aria-label=\"How many parcels of real estate do you own?\">How many parcels of real estate do you own?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_1\" id=\"ff_8_dropdown_1\" class=\"ff-el-form-control\" data-name=\"dropdown_1\" data-calc_value=\"0\" tabindex=\"31\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_8_dropdown_1\"><option value=\"\">- Select -<\/option><option value=\"1\"  >1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"More than 3\"  >More than 3<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_6\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_8_dropdown_9' id='label_ff_8_dropdown_9' aria-label=\"How many vehicles are there in your household?\">How many vehicles are there in your household?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_9\" id=\"ff_8_dropdown_9\" class=\"ff-el-form-control\" data-name=\"dropdown_9\" data-calc_value=\"0\" tabindex=\"32\"  aria-invalid=\"false\" aria-required=\"true\" aria-labelledby=\"label_ff_8_dropdown_9\"><option value=\"\">- Select -<\/option><option value=\"0\"  >0<\/option><option value=\"1\"  >1<\/option><option value=\"2\"  >2<\/option><option value=\"3 or more\"  >3 or more<\/option><\/select><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Were you required to file federal income tax returns for the last two years?\">Were you required to file federal income tax returns for the last two years?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_46_a1e9d7da4c082781fcfd3e9000be0075'><input  type=\"radio\" name=\"input_radio_46\" data-name=\"input_radio_46\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"33\" value=\"yes\"  id='input_radio_46_a1e9d7da4c082781fcfd3e9000be0075' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_46_1f55630f1d272141896bc000266b03b9'><input  type=\"radio\" name=\"input_radio_46\" data-name=\"input_radio_46\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_46_1f55630f1d272141896bc000266b03b9' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_7\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Have you filed for bankruptcy before?\">Have you filed for bankruptcy before?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_3b6ce34773cfa98865832f35b774eafe'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"34\" value=\"yes\"  id='input_radio_3_3b6ce34773cfa98865832f35b774eafe' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_3_6f8b7ad790caeb4238553b5c5ebabdaf'><input  type=\"radio\" name=\"input_radio_3\" data-name=\"input_radio_3\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_3_6f8b7ad790caeb4238553b5c5ebabdaf' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Has your spouse filed for bankruptcy before?\">Has your spouse filed for bankruptcy before?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_f6b52b43ca134e6cd13f52321adf26ab'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"35\" value=\"Yes\"  id='input_radio_4_f6b52b43ca134e6cd13f52321adf26ab' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_4_564cfe28f871148f491dee09a9878de4'><input  type=\"radio\" name=\"input_radio_4\" data-name=\"input_radio_4\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"No\"  id='input_radio_4_564cfe28f871148f491dee09a9878de4' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;' tabindex='36'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;' tabindex='37'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_2\" ><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_3\" ><h3 class='ff-el-section-title'>Household Income<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_8\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label   aria-label=\"Are you currently employed?\">Are you currently employed?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_6_e672bbf9a4dfcd1701af77fac4092b0c'><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"38\" value=\"yes\"  id='input_radio_6_e672bbf9a4dfcd1701af77fac4092b0c' aria-label='Yes' aria-invalid='false' aria-required=true> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_6_f35fd69dfa79edb11feaaf15e33067df'><input  type=\"radio\" name=\"input_radio_6\" data-name=\"input_radio_6\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_6_f35fd69dfa79edb11feaaf15e33067df' aria-label='No' aria-invalid='false' aria-required=true> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is your spouse currently employed?\">Is your spouse currently employed?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_8c60e44050923b38843cf9036eeb2bd1'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"39\" value=\"yes\"  id='input_radio_5_8c60e44050923b38843cf9036eeb2bd1' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_5_9bd29715e0408065740673f83e77f8c0'><input  type=\"radio\" name=\"input_radio_5\" data-name=\"input_radio_5\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_5_9bd29715e0408065740673f83e77f8c0' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_4' id='label_ff_8_input_text_4' aria-label=\"Name of Employer\">Name of Employer<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_4\" class=\"ff-el-form-control\" placeholder=\"Company Name\" data-name=\"input_text_4\" tabindex=\"40\" id=\"ff_8_input_text_4\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address has-conditions\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=\"Employer Address\">Employer Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address_1_address_line_1_' id='label_ff_8_address_1_address_line_1_' aria-label=\"Address Line 1\">Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_8_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\" tabindex=\"41\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address_1_address_line_2_' id='label_ff_8_address_1_address_line_2_' aria-label=\"Address Line 2\">Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_8_address_1_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Address Line 2\" data-key_name=\"address_line_2\" tabindex=\"42\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address_1_city_' id='label_ff_8_address_1_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_8_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\" tabindex=\"43\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address_1_state_' id='label_ff_8_address_1_state_' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[state]\" id=\"ff_8_address_1_state_\" class=\"ff-el-form-control\" placeholder=\"Michigan\" data-key_name=\"state\" tabindex=\"44\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address_1_zip_' id='label_ff_8_address_1_zip_' aria-label=\"Zip Code\">Zip Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_8_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Zip\" data-key_name=\"zip\" tabindex=\"45\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_5' id='label_ff_8_input_text_5' aria-label=\"What is your position there?\">What is your position there?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_5\" class=\"ff-el-form-control\" placeholder=\"Job title\" data-name=\"input_text_5\" tabindex=\"46\" id=\"ff_8_input_text_5\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-name=\"ff_cn_id_9\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_6' id='label_ff_8_input_text_6' aria-label=\"How long have you worked there?\">How long have you worked there?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_6\" class=\"ff-el-form-control\" placeholder=\"2.5 years\" data-name=\"input_text_6\" tabindex=\"47\" id=\"ff_8_input_text_6\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you expect this job to end within in the next year?\">Do you expect this job to end within in the next year?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_045388491b7c7f6630ce951bf2533494'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"48\" value=\"yes\"  id='input_radio_8_045388491b7c7f6630ce951bf2533494' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_8_182ef82d228c8003e0fac19df5063bd3'><input  type=\"radio\" name=\"input_radio_8\" data-name=\"input_radio_8\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_8_182ef82d228c8003e0fac19df5063bd3' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"How often are you paid?\">How often are you paid?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_c68d8d8d8d0ff722a6ef0973dfdbc070'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"49\" value=\"Weekly\"  id='input_radio_7_c68d8d8d8d0ff722a6ef0973dfdbc070' aria-label='Weekly' aria-invalid='false' aria-required=false> <span>Weekly<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_0447c0f294b8ee7a52341879c8b206e3'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Every two weeks\"  id='input_radio_7_0447c0f294b8ee7a52341879c8b206e3' aria-label='Every two weeks' aria-invalid='false' aria-required=false> <span>Every two weeks<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_0c991cb869a0689ab9017da9b509d29b'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Twice monthly\"  id='input_radio_7_0c991cb869a0689ab9017da9b509d29b' aria-label='Twice monthly' aria-invalid='false' aria-required=false> <span>Twice monthly<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_d165d284dad09b5bd6483e7250467e5b'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Monthly\"  id='input_radio_7_d165d284dad09b5bd6483e7250467e5b' aria-label='Monthly' aria-invalid='false' aria-required=false> <span>Monthly<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_7_693b934ac381e9ad7eace9d2ef1e1e7b'><input  type=\"radio\" name=\"input_radio_7\" data-name=\"input_radio_7\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Other\"  id='input_radio_7_693b934ac381e9ad7eace9d2ef1e1e7b' aria-label='Other' aria-invalid='false' aria-required=false> <span>Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field' id='label_ff_8_numeric-field' aria-label=\"What are your average gross earnings per check (before tax withholdings and deductions)?\">What are your average gross earnings per check (before tax withholdings and deductions)?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field\" id=\"ff_8_numeric-field\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"ex: 2,000.00\" data-name=\"numeric-field\" inputmode=\"numeric\" step=\"any\" min=\"50\" aria-valuemin=\"50\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"50\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_7' id='label_ff_8_input_text_7' aria-label=\"Name of Spouse&#039;s Employer\">Name of Spouse's Employer<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_7\" class=\"ff-el-form-control\" placeholder=\"Company Name\" data-name=\"input_text_7\" tabindex=\"51\" id=\"ff_8_input_text_7\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address has-conditions\" data-type=\"address-element\" data-name=\"address4\" ><div class='ff-el-input--label'><label aria-label=\"Spouse&#039;s Employer Address\">Spouse's Employer Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address4_address_line_1_' id='label_ff_8_address4_address_line_1_' aria-label=\"Address Line 1\">Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address4[address_line_1]\" id=\"ff_8_address4_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\" tabindex=\"52\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address4_address_line_2_' id='label_ff_8_address4_address_line_2_' aria-label=\"Address Line 2\">Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address4[address_line_2]\" id=\"ff_8_address4_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Address Line 2\" data-key_name=\"address_line_2\" tabindex=\"53\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address4_city_' id='label_ff_8_address4_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address4[city]\" id=\"ff_8_address4_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\" tabindex=\"54\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address4_state_' id='label_ff_8_address4_state_' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address4[state]\" id=\"ff_8_address4_state_\" class=\"ff-el-form-control\" placeholder=\"Michigan\" data-key_name=\"state\" tabindex=\"55\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address4_zip_' id='label_ff_8_address4_zip_' aria-label=\"Zip Code\">Zip Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address4[zip]\" id=\"ff_8_address4_zip_\" class=\"ff-el-form-control\" placeholder=\"Zip\" data-key_name=\"zip\" tabindex=\"56\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_8' id='label_ff_8_input_text_8' aria-label=\"What is your spouse&#039;s position there?\">What is your spouse's position there?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_8\" class=\"ff-el-form-control\" placeholder=\"Job title\" data-name=\"input_text_8\" tabindex=\"57\" id=\"ff_8_input_text_8\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-name=\"ff_cn_id_10\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_9' id='label_ff_8_input_text_9' aria-label=\"How long has your spouse worked there?\">How long has your spouse worked there?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_9\" class=\"ff-el-form-control\" placeholder=\"2.5 years\" data-name=\"input_text_9\" tabindex=\"58\" id=\"ff_8_input_text_9\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you expect this job to end within in the next year?\">Do you expect this job to end within in the next year?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_4bdade5ee8b1eac81a41bc30f9d6bab3'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"59\" value=\"yes\"  id='input_radio_9_4bdade5ee8b1eac81a41bc30f9d6bab3' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_9_33470717d5cdcd1cbb470c859a81dd72'><input  type=\"radio\" name=\"input_radio_9\" data-name=\"input_radio_9\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_9_33470717d5cdcd1cbb470c859a81dd72' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"How often is your spouse paid?\">How often is your spouse paid?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_a10e2de724e64a65942c611f58b1393f'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"60\" value=\"Weekly\"  id='input_radio_10_a10e2de724e64a65942c611f58b1393f' aria-label='Weekly' aria-invalid='false' aria-required=false> <span>Weekly<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_4be71e46cfb39f81952acbdc96f4092d'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Every two weeks\"  id='input_radio_10_4be71e46cfb39f81952acbdc96f4092d' aria-label='Every two weeks' aria-invalid='false' aria-required=false> <span>Every two weeks<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_32947014ee37e646244d0a0da48da497'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Twice monthly\"  id='input_radio_10_32947014ee37e646244d0a0da48da497' aria-label='Twice monthly' aria-invalid='false' aria-required=false> <span>Twice monthly<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_f786096e092deac730d74ef8e4aad4e3'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Monthly\"  id='input_radio_10_f786096e092deac730d74ef8e4aad4e3' aria-label='Monthly' aria-invalid='false' aria-required=false> <span>Monthly<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_10_6e09ea9c8fac0951446e8ebd4af97bf0'><input  type=\"radio\" name=\"input_radio_10\" data-name=\"input_radio_10\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"Other\"  id='input_radio_10_6e09ea9c8fac0951446e8ebd4af97bf0' aria-label='Other' aria-invalid='false' aria-required=false> <span>Other<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_5' id='label_ff_8_numeric-field_5' aria-label=\"What are your average gross earnings per check (before tax withholdings and deductions)?\">What are your average gross earnings per check (before tax withholdings and deductions)?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field_5\" id=\"ff_8_numeric-field_5\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"ex: 2,000.00\" data-name=\"numeric-field_5\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"61\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Please select all other sources of your household income:\">Please select all other sources of your household income:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_d8687bb5efdd9ce8253285b3842a1387'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"62\" value=\"Self-employment\"  id='checkbox_d8687bb5efdd9ce8253285b3842a1387' aria-label='Self-employment' aria-invalid='false' aria-required=false> <span>Self-employment<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_0dfad248996f1ab75fb03790bff3a35c'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Unemployment income\"  id='checkbox_0dfad248996f1ab75fb03790bff3a35c' aria-label='Unemployment income' aria-invalid='false' aria-required=false> <span>Unemployment income<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_48446a9279222ae88a0fdab784b450b0'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Receive family support (child or spousal support)\"  id='checkbox_48446a9279222ae88a0fdab784b450b0' aria-label='Receive family support (child or spousal support)' aria-invalid='false' aria-required=false> <span>Receive family support (child or spousal support)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_87b03d389b68693730978fc0b5e054b4'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Public assistance (welfare, food assistance, etc.)\"  id='checkbox_87b03d389b68693730978fc0b5e054b4' aria-label='Public assistance (welfare, food assistance, etc.)' aria-invalid='false' aria-required=false> <span>Public assistance (welfare, food assistance, etc.)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_715a7e2984e5d6726d9d0cde37378b94'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Worker&#039;s compensation or disability insurance \"  id='checkbox_715a7e2984e5d6726d9d0cde37378b94' aria-label='Worker&#039;s compensation or disability insurance' aria-invalid='false' aria-required=false> <span>Worker's compensation or disability insurance <\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_975730836ad77bdde709ecd8d2648bc3'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Social Security or Social Security Disability Income\"  id='checkbox_975730836ad77bdde709ecd8d2648bc3' aria-label='Social Security or Social Security Disability Income' aria-invalid='false' aria-required=false> <span>Social Security or Social Security Disability Income<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_e96f6d229eec0005db7d0335b15b4e13'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Pension or retirement income\"  id='checkbox_e96f6d229eec0005db7d0335b15b4e13' aria-label='Pension or retirement income' aria-invalid='false' aria-required=false> <span>Pension or retirement income<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2b6ea6eb6032c0e69d2ce45a9404031c'><input  type=\"checkbox\" name=\"checkbox[]\" data-name=\"checkbox\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Other\"  id='checkbox_2b6ea6eb6032c0e69d2ce45a9404031c' aria-label='Other' aria-invalid='false' aria-required=false> <span>Other<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_left\" data-name=\"section_break-8_4\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p>Please tell us a little more about the other household income sources indicated:<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_11\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text' id='label_ff_8_input_text' aria-label=\"What is the name of the business?\">What is the name of the business?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"My Company, LLC\" data-name=\"input_text\" tabindex=\"63\" id=\"ff_8_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_11' id='label_ff_8_input_text_11' aria-label=\"What is the nature of your business?\">What is the nature of your business?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_11\" class=\"ff-el-form-control\" placeholder=\"Professional lawncare and landscaping\" data-name=\"input_text_11\" tabindex=\"64\" id=\"ff_8_input_text_11\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_42' id='label_ff_8_numeric-field_42' aria-label=\"What percentage of the business do you own?\">What percentage of the business do you own?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><input type=\"text\" name=\"numeric-field_42\" id=\"ff_8_numeric-field_42\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"Example: 100\" data-name=\"numeric-field_42\" inputmode=\"numeric\" step=\"any\" min=\"1\" aria-valuemin=\"1\" max=\"100\" aria-valuemax=\"100\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"65\"  aria-invalid=\"false\" aria-required=false><div class=\"ff_input-group-append\"><span class=\"ff_input-group-text\">%<\/span><\/div><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_24' id='label_ff_8_input_text_24' aria-label=\"When did you start or buy into the business?\">When did you start or buy into the business?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_24\" class=\"ff-el-form-control\" placeholder=\"12\/31\/2021\" data-name=\"input_text_24\" tabindex=\"66\" id=\"ff_8_input_text_24\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_12\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_25' id='label_ff_8_input_text_25' aria-label=\"When did you start receiving unemployment income?\">When did you start receiving unemployment income?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_25\" class=\"ff-el-form-control\" placeholder=\"12\/31\/2021\" data-name=\"input_text_25\" tabindex=\"67\" id=\"ff_8_input_text_25\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_7' id='label_ff_8_numeric-field_7' aria-label=\"How much are you receiving in unemployment weekly?\">How much are you receiving in unemployment weekly?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_7\" value=\"0.00\" id=\"ff_8_numeric-field_7\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_7\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"68\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_13\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is your family support income court ordered?\">Is your family support income court ordered?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_12_28bf57f2ae907e94b8317df4ff7b5d48'><input  type=\"radio\" name=\"input_radio_12\" data-name=\"input_radio_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"69\" value=\"yes\"  id='input_radio_12_28bf57f2ae907e94b8317df4ff7b5d48' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_12_8d4d6093e92ea4ebe5aba07c88f62106'><input  type=\"radio\" name=\"input_radio_12\" data-name=\"input_radio_12\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_12_8d4d6093e92ea4ebe5aba07c88f62106' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_8' id='label_ff_8_numeric-field_8' aria-label=\"How much do you receive in family support monthly?\">How much do you receive in family support monthly?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_8\" value=\"0.00\" id=\"ff_8_numeric-field_8\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_8\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"70\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_14\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_26' id='label_ff_8_input_text_26' aria-label=\"When did you start receiving public assistance?\">When did you start receiving public assistance?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_26\" class=\"ff-el-form-control\" placeholder=\"12\/31\/2021\" data-name=\"input_text_26\" tabindex=\"71\" id=\"ff_8_input_text_26\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_9' id='label_ff_8_numeric-field_9' aria-label=\"How much assistance do you receive monthly?\">How much assistance do you receive monthly?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_9\" value=\"0.00\" id=\"ff_8_numeric-field_9\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_9\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"72\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_15\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_27' id='label_ff_8_input_text_27' aria-label=\"When did you start receiving worker&#039;s compensation or disability insurance?\">When did you start receiving worker's compensation or disability insurance?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_27\" class=\"ff-el-form-control\" placeholder=\"12\/31\/2021\" data-name=\"input_text_27\" tabindex=\"73\" id=\"ff_8_input_text_27\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_10' id='label_ff_8_numeric-field_10' aria-label=\"How much do you receive in monthly from worker&#039;s compensation or disability insurance?\">How much do you receive in monthly from worker's compensation or disability insurance?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_10\" value=\"0.00\" id=\"ff_8_numeric-field_10\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_10\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"74\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_16\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_28' id='label_ff_8_input_text_28' aria-label=\"When did you start receiving Social Security Income?\">When did you start receiving Social Security Income?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_28\" class=\"ff-el-form-control\" placeholder=\"12\/31\/2021\" data-name=\"input_text_28\" tabindex=\"75\" id=\"ff_8_input_text_28\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_11' id='label_ff_8_numeric-field_11' aria-label=\"How much do you get monthly from Social Security?\">How much do you get monthly from Social Security?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_11\" value=\"0.00\" id=\"ff_8_numeric-field_11\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_11\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"76\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_17\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_29' id='label_ff_8_input_text_29' aria-label=\"When did you start receiving pension income?\">When did you start receiving pension income?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_29\" class=\"ff-el-form-control\" placeholder=\"12\/31\/2021\" data-name=\"input_text_29\" tabindex=\"77\" id=\"ff_8_input_text_29\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_12' id='label_ff_8_numeric-field_12' aria-label=\"How much is your total monthly pension income?\">How much is your total monthly pension income?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_12\" value=\"0.00\" id=\"ff_8_numeric-field_12\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_12\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"78\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_18\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_12' id='label_ff_8_input_text_12' aria-label=\"What are the other sources of income for the household?\">What are the other sources of income for the household?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_12\" class=\"ff-el-form-control\" placeholder=\"Ex: babysitting for friends or walking dogs for neighbors, etc.\" data-name=\"input_text_12\" tabindex=\"79\" id=\"ff_8_input_text_12\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_13' id='label_ff_8_numeric-field_13' aria-label=\"How much annually does your household receive from these other sources of income?\">How much annually does your household receive from these other sources of income?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_13\" value=\"0.00\" id=\"ff_8_numeric-field_13\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_13\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"80\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;' tabindex='81'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;' tabindex='82'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_5\" ><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_6\" ><h3 class='ff-el-section-title'>Household Expenses<\/h3><div class='ff-section_break_desk'><p>Please enter your rough estimates of the following expenses for an average month. It might help to think of your weekly or annual expenses in some areas and then convert them to monthly figures.<\/p><\/div><hr \/><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_38' id='label_ff_8_numeric-field_38' aria-label=\"How much is your rent per month?\">How much is your rent per month?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_38\" id=\"ff_8_numeric-field_38\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_38\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"83\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div data-name=\"ff_cn_id_19\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Please select any household expenses below that you are at least partially responsible for paying:\">Please select any household expenses below that you are at least partially responsible for paying:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_12b7c1ce3439655bc57d238a9918d628'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"84\" value=\"Electricity\"  id='checkbox_1_12b7c1ce3439655bc57d238a9918d628' aria-label='Electricity' aria-invalid='false' aria-required=false> <span>Electricity<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_a02eb57e019aea9161d17083e1422346'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Natural gas\"  id='checkbox_1_a02eb57e019aea9161d17083e1422346' aria-label='Natural gas' aria-invalid='false' aria-required=false> <span>Natural gas<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_ccf0750becf6eb4c7813f2b322c3dde6'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Water &amp; sewer\"  id='checkbox_1_ccf0750becf6eb4c7813f2b322c3dde6' aria-label='Water &amp; sewer' aria-invalid='false' aria-required=false> <span>Water &amp; sewer<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_4eef4ef7aef3cab8064f65986a5b68ef'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Trash removal\"  id='checkbox_1_4eef4ef7aef3cab8064f65986a5b68ef' aria-label='Trash removal' aria-invalid='false' aria-required=false> <span>Trash removal<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_b754d1146d70e3fd8e439489376b49d5'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Phone\/cell phones\"  id='checkbox_1_b754d1146d70e3fd8e439489376b49d5' aria-label='Phone\/cell phones' aria-invalid='false' aria-required=false> <span>Phone\/cell phones<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_e5e4ea975f6af98fb0f92d2776bde9bc'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Cable and internet services\"  id='checkbox_1_e5e4ea975f6af98fb0f92d2776bde9bc' aria-label='Cable and internet services' aria-invalid='false' aria-required=false> <span>Cable and internet services<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_7\" ><p>How much do you spend in an average month?<\/p><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_43' id='label_ff_8_numeric-field_43' aria-label=\"Electricity amount\">Electricity amount<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_43\" id=\"ff_8_numeric-field_43\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_43\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"85\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_48' id='label_ff_8_numeric-field_48' aria-label=\"Natural gas amount\">Natural gas amount<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_48\" id=\"ff_8_numeric-field_48\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_48\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"86\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_47' id='label_ff_8_numeric-field_47' aria-label=\"Water &amp; sewer amount\">Water &amp; sewer amount<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_47\" id=\"ff_8_numeric-field_47\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_47\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"87\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_46' id='label_ff_8_numeric-field_46' aria-label=\"Trash removal amount\">Trash removal amount<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_46\" id=\"ff_8_numeric-field_46\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_46\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"88\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_45' id='label_ff_8_numeric-field_45' aria-label=\"Phone\/cell phone service\">Phone\/cell phone service<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_45\" id=\"ff_8_numeric-field_45\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_45\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"89\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_44' id='label_ff_8_numeric-field_44' aria-label=\"Cable and internet services\">Cable and internet services<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_44\" id=\"ff_8_numeric-field_44\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_44\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"90\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_49' id='label_ff_8_numeric-field_49' aria-label=\"Food and groceries:\">Food and groceries:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_49\" id=\"ff_8_numeric-field_49\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_49\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"91\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_50' id='label_ff_8_numeric-field_50' aria-label=\"Clothing (buying clothes, dry cleaning, laundry):\">Clothing (buying clothes, dry cleaning, laundry):<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"number\" name=\"numeric-field_50\" id=\"ff_8_numeric-field_50\" class=\"ff-el-form-control\" placeholder=\"enter amount\" data-name=\"numeric-field_50\" inputmode=\"numeric\" step=\"any\" tabindex=\"92\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_51' id='label_ff_8_numeric-field_51' aria-label=\"Out of pocket medical expenses (co-pays, prescriptions, vitamins, medical supplies, etc.):\">Out of pocket medical expenses (co-pays, prescriptions, vitamins, medical supplies, etc.):<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"number\" name=\"numeric-field_51\" id=\"ff_8_numeric-field_51\" class=\"ff-el-form-control\" placeholder=\"enter amount\" data-name=\"numeric-field_51\" inputmode=\"numeric\" step=\"any\" tabindex=\"93\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_52' id='label_ff_8_numeric-field_52' aria-label=\"Personal care and grooming (toiletries, haircuts, salon, make-up, etc.):\">Personal care and grooming (toiletries, haircuts, salon, make-up, etc.):<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_52\" id=\"ff_8_numeric-field_52\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_52\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"94\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_8\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p>Transportation<\/p><\/div><hr \/><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_53' id='label_ff_8_numeric-field_53' aria-label=\"Gasoline\">Gasoline<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_53\" id=\"ff_8_numeric-field_53\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_53\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"95\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_75' id='label_ff_8_numeric-field_75' aria-label=\"Auto Maintenance\">Auto Maintenance<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_75\" id=\"ff_8_numeric-field_75\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_75\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"96\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_54' id='label_ff_8_numeric-field_54' aria-label=\"Public transportation, Uber, Lyft, etc.\">Public transportation, Uber, Lyft, etc.<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"number\" name=\"numeric-field_54\" id=\"ff_8_numeric-field_54\" class=\"ff-el-form-control\" placeholder=\"enter amount\" data-name=\"numeric-field_54\" inputmode=\"numeric\" step=\"any\" tabindex=\"97\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_9\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p>Insurance Expenses for the Household<\/p><\/div><hr \/><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_39' id='label_ff_8_numeric-field_39' aria-label=\"How much is your renter&#039;s insurance per month?\">How much is your renter's insurance per month?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_39\" id=\"ff_8_numeric-field_39\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_39\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"98\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_56' id='label_ff_8_numeric-field_56' aria-label=\"Homeowner&#039;s insurance if not included in mortgage payment\">Homeowner's insurance if not included in mortgage payment<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_56\" id=\"ff_8_numeric-field_56\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_56\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"99\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_57' id='label_ff_8_numeric-field_57' aria-label=\"Car insurance\">Car insurance<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_57\" id=\"ff_8_numeric-field_57\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_57\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"100\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_58' id='label_ff_8_numeric-field_58' aria-label=\"Life insurance if not payroll deducted\">Life insurance if not payroll deducted<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_58\" id=\"ff_8_numeric-field_58\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_58\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"101\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_59' id='label_ff_8_numeric-field_59' aria-label=\"Health insurance if not payroll deducted\">Health insurance if not payroll deducted<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_59\" id=\"ff_8_numeric-field_59\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_59\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"102\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div data-name=\"ff_cn_id_20\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Please select other monthly expenses you have:\">Please select other monthly expenses you have:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_d1a03e5a62c3c73cd9f75e1f0c153965'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"103\" value=\"Pet expenses\"  id='checkbox_3_d1a03e5a62c3c73cd9f75e1f0c153965' aria-label='Pet expenses' aria-invalid='false' aria-required=false> <span>Pet expenses<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_256167657ecdafa77c61bd6390858ffc'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Gym memberships\"  id='checkbox_3_256167657ecdafa77c61bd6390858ffc' aria-label='Gym memberships' aria-invalid='false' aria-required=false> <span>Gym memberships<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_5be8ca13f6afa4752cec5bb8ce639ad5'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Recreation and entertainment\"  id='checkbox_3_5be8ca13f6afa4752cec5bb8ce639ad5' aria-label='Recreation and entertainment' aria-invalid='false' aria-required=false> <span>Recreation and entertainment<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_0ed0d63b4588f54dabfcae274e09b7fd'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Child support \/ spousal support\"  id='checkbox_3_0ed0d63b4588f54dabfcae274e09b7fd' aria-label='Child support \/ spousal support' aria-invalid='false' aria-required=false> <span>Child support \/ spousal support<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_0d9810768b5025dee399c2a7c0558540'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Child \/ dependent care\"  id='checkbox_3_0d9810768b5025dee399c2a7c0558540' aria-label='Child \/ dependent care' aria-invalid='false' aria-required=false> <span>Child \/ dependent care<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_4ffe60dd73407db54052aa2e6c3ced2a'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"School expenses\"  id='checkbox_3_4ffe60dd73407db54052aa2e6c3ced2a' aria-label='School expenses' aria-invalid='false' aria-required=false> <span>School expenses<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_7e48eeaebff544a0a84ac18b0dac082b'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Children&#039;s activities (dance, soccer, etc.)\"  id='checkbox_3_7e48eeaebff544a0a84ac18b0dac082b' aria-label='Children&#039;s activities (dance, soccer, etc.)' aria-invalid='false' aria-required=false> <span>Children's activities (dance, soccer, etc.)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_5bd99693f916e933b6d834827e6da039'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Tuition (Not loans)\"  id='checkbox_3_5bd99693f916e933b6d834827e6da039' aria-label='Tuition (Not loans)' aria-invalid='false' aria-required=false> <span>Tuition (Not loans)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_a3be5bcfe8b02a8fa8ae44134b5bc1c7'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Student loan payments\"  id='checkbox_3_a3be5bcfe8b02a8fa8ae44134b5bc1c7' aria-label='Student loan payments' aria-invalid='false' aria-required=false> <span>Student loan payments<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_23142db8dca0c210057f92362c51ba59'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Cigarettes \/ vaping supplies\"  id='checkbox_3_23142db8dca0c210057f92362c51ba59' aria-label='Cigarettes \/ vaping supplies' aria-invalid='false' aria-required=false> <span>Cigarettes \/ vaping supplies<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_cf345ed3f18e9258663cf4a30ac94c6c'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Physical therapy\"  id='checkbox_3_cf345ed3f18e9258663cf4a30ac94c6c' aria-label='Physical therapy' aria-invalid='false' aria-required=false> <span>Physical therapy<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_7ef74d9f1c38b7936bb83bf8cf566ce4'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Alarm system\"  id='checkbox_3_7ef74d9f1c38b7936bb83bf8cf566ce4' aria-label='Alarm system' aria-invalid='false' aria-required=false> <span>Alarm system<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_cb111c7b7d95685e77261c9699d73d61'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Storage fees\"  id='checkbox_3_cb111c7b7d95685e77261c9699d73d61' aria-label='Storage fees' aria-invalid='false' aria-required=false> <span>Storage fees<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_9f3c230c1ded5dd065bbfbb49de5bffb'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Dentist \/ orthodontist expenses\"  id='checkbox_3_9f3c230c1ded5dd065bbfbb49de5bffb' aria-label='Dentist \/ orthodontist expenses' aria-invalid='false' aria-required=false> <span>Dentist \/ orthodontist expenses<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_3d7c8c5f542f40b495ee9a389277a98e'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Subscriptions\"  id='checkbox_3_3d7c8c5f542f40b495ee9a389277a98e' aria-label='Subscriptions' aria-invalid='false' aria-required=false> <span>Subscriptions<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_3_f53c564088d24f12229847673f481bf1'><input  type=\"checkbox\" name=\"checkbox_3[]\" data-name=\"checkbox_3\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Cash charitable contributions or tithing\"  id='checkbox_3_f53c564088d24f12229847673f481bf1' aria-label='Cash charitable contributions or tithing' aria-invalid='false' aria-required=false> <span>Cash charitable contributions or tithing<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_10\" ><p>Please enter the average monthly cost by type:<\/p><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_74' id='label_ff_8_numeric-field_74' aria-label=\"Pet expenses:\">Pet expenses:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_74\" id=\"ff_8_numeric-field_74\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_74\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"104\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_89' id='label_ff_8_numeric-field_89' aria-label=\"Gym memberships:\">Gym memberships:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_89\" id=\"ff_8_numeric-field_89\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_89\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"105\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_88' id='label_ff_8_numeric-field_88' aria-label=\"Recreation and entertainment:\">Recreation and entertainment:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_88\" id=\"ff_8_numeric-field_88\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_88\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"106\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_87' id='label_ff_8_numeric-field_87' aria-label=\"Child and\/or spousal support:\">Child and\/or spousal support:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_87\" id=\"ff_8_numeric-field_87\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_87\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"107\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_86' id='label_ff_8_numeric-field_86' aria-label=\"Childcare \/ dependent care:\">Childcare \/ dependent care:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_86\" id=\"ff_8_numeric-field_86\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_86\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"108\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_85' id='label_ff_8_numeric-field_85' aria-label=\"School expenses:\">School expenses:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_85\" id=\"ff_8_numeric-field_85\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_85\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"109\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_84' id='label_ff_8_numeric-field_84' aria-label=\"Children&#039;s activities:\">Children's activities:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_84\" id=\"ff_8_numeric-field_84\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_84\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"110\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_83' id='label_ff_8_numeric-field_83' aria-label=\"Out of pocket tuition:\">Out of pocket tuition:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_83\" id=\"ff_8_numeric-field_83\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_83\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"111\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_82' id='label_ff_8_numeric-field_82' aria-label=\"Student loan payments:\">Student loan payments:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_82\" id=\"ff_8_numeric-field_82\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_82\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"112\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_81' id='label_ff_8_numeric-field_81' aria-label=\"Cigarettes \/ tobacco \/ vaping:\">Cigarettes \/ tobacco \/ vaping:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_81\" id=\"ff_8_numeric-field_81\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_81\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"113\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_80' id='label_ff_8_numeric-field_80' aria-label=\"Physical therapy:\">Physical therapy:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_80\" id=\"ff_8_numeric-field_80\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_80\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"114\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_79' id='label_ff_8_numeric-field_79' aria-label=\"Alarm systems:\">Alarm systems:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_79\" id=\"ff_8_numeric-field_79\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_79\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"115\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_78' id='label_ff_8_numeric-field_78' aria-label=\"Storage fees:\">Storage fees:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_78\" id=\"ff_8_numeric-field_78\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_78\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"116\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_77' id='label_ff_8_numeric-field_77' aria-label=\"Dentist \/ orthodontist:\">Dentist \/ orthodontist:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_77\" id=\"ff_8_numeric-field_77\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_77\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"117\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_76' id='label_ff_8_numeric-field_76' aria-label=\"Subscriptions:\">Subscriptions:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_76\" id=\"ff_8_numeric-field_76\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_76\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"118\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_90' id='label_ff_8_numeric-field_90' aria-label=\"Cash charitable contributions:\">Cash charitable contributions:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_90\" id=\"ff_8_numeric-field_90\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_90\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"119\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;' tabindex='120'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;' tabindex='121'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_11\" ><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_left\" data-name=\"section_break-8_12\" ><h3 class='ff-el-section-title'>Real Property<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_13' id='label_ff_8_input_text_13' aria-label=\"Please list all names that are on the deed to your home or real property:\">Please list all names that are on the deed to your home or real property:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_13\" class=\"ff-el-form-control\" placeholder=\"Ex: John Doe, Jane Doe, and Dory Doe\" data-name=\"input_text_13\" tabindex=\"122\" id=\"ff_8_input_text_13\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div data-name=\"ff_cn_id_21\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a mortgage on the property?\">Is there a mortgage on the property?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_16_9f685e4bc1839a87bbf95c2f44580114'><input  type=\"radio\" name=\"input_radio_16\" data-name=\"input_radio_16\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"123\" value=\"yes\"  id='input_radio_16_9f685e4bc1839a87bbf95c2f44580114' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_16_63bc058bc2c021bb690828d99aee6b80'><input  type=\"radio\" name=\"input_radio_16\" data-name=\"input_radio_16\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_16_63bc058bc2c021bb690828d99aee6b80' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are you current on the mortgage?\">Are you current on the mortgage?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_18_a9ebf61c1898c15d715dfda5bfabe3b4'><input  type=\"radio\" name=\"input_radio_18\" data-name=\"input_radio_18\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"124\" value=\"yes\"  id='input_radio_18_a9ebf61c1898c15d715dfda5bfabe3b4' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_18_464d5825a5afa14438a09e3e42196f7c'><input  type=\"radio\" name=\"input_radio_18\" data-name=\"input_radio_18\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_18_464d5825a5afa14438a09e3e42196f7c' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_dropdown_2' id='label_ff_8_dropdown_2' aria-label=\"How many months behind are you?\">How many months behind are you?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_8_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\" tabindex=\"125\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_8_dropdown_2\"><option value=\"\">- Select -<\/option><option value=\"1\"  >1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"4\"  >4<\/option><option value=\"5\"  >5<\/option><option value=\"6 or more\"  >6 or more<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_22\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_15' id='label_ff_8_numeric-field_15' aria-label=\"What is your monthly mortgage payment amount?\">What is your monthly mortgage payment amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_15\" id=\"ff_8_numeric-field_15\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_15\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"126\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are the taxes and insurance included in the payment?\">Are the taxes and insurance included in the payment?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_19_b73417ce083b6b8daf6c915d63083fc4'><input  type=\"radio\" name=\"input_radio_19\" data-name=\"input_radio_19\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"127\" value=\"yes\"  id='input_radio_19_b73417ce083b6b8daf6c915d63083fc4' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_19_0b66ecd4549f9d76428dd263db534865'><input  type=\"radio\" name=\"input_radio_19\" data-name=\"input_radio_19\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_19_0b66ecd4549f9d76428dd263db534865' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_16' id='label_ff_8_numeric-field_16' aria-label=\"What is the approximate total principal balance owed?\">What is the approximate total principal balance owed?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_16\" id=\"ff_8_numeric-field_16\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_16\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"128\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_18' id='label_ff_8_numeric-field_18' aria-label=\"How much do you pay annually in property tax?\">How much do you pay annually in property tax?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_18\" id=\"ff_8_numeric-field_18\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_18\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"129\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_23\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a second mortgage or lien on this property?\">Is there a second mortgage or lien on this property?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_20_924f613e640e0d056f207a6b433a3dcb'><input  type=\"radio\" name=\"input_radio_20\" data-name=\"input_radio_20\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"130\" value=\"yes\"  id='input_radio_20_924f613e640e0d056f207a6b433a3dcb' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_20_beee136f54d289d7769d15d43a7486f1'><input  type=\"radio\" name=\"input_radio_20\" data-name=\"input_radio_20\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_20_beee136f54d289d7769d15d43a7486f1' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are you current on second lien payments?\">Are you current on second lien payments?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_45_12bdec6e30bd130bd41e67732d34ff1f'><input  type=\"radio\" name=\"input_radio_45\" data-name=\"input_radio_45\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"131\" value=\"yes\"  id='input_radio_45_12bdec6e30bd130bd41e67732d34ff1f' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_45_9e18f98fd1d5d1e762afb870d1fab7f6'><input  type=\"radio\" name=\"input_radio_45\" data-name=\"input_radio_45\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_45_9e18f98fd1d5d1e762afb870d1fab7f6' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_21' id='label_ff_8_numeric-field_21' aria-label=\"What is the approximate balance owed on this lien?\">What is the approximate balance owed on this lien?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_21\" id=\"ff_8_numeric-field_21\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_21\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"132\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_19' id='label_ff_8_numeric-field_19' aria-label=\"What is your monthly second lien payment amount?\">What is your monthly second lien payment amount?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field_19\" id=\"ff_8_numeric-field_19\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"$\" data-name=\"numeric-field_19\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"133\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_22' id='label_ff_8_numeric-field_22' aria-label=\"What is the current past due amount?\">What is the current past due amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_22\" id=\"ff_8_numeric-field_22\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_22\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"134\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_24\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you wish to keep this property?\">Do you wish to keep this property?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_21_5461b824bb540f2b323db1236df28d5d'><input  type=\"radio\" name=\"input_radio_21\" data-name=\"input_radio_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"135\" value=\"yes\"  id='input_radio_21_5461b824bb540f2b323db1236df28d5d' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_21_9ad56650e1b0d4513f2c1dfb6b0acc86'><input  type=\"radio\" name=\"input_radio_21\" data-name=\"input_radio_21\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_21_9ad56650e1b0d4513f2c1dfb6b0acc86' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_23' id='label_ff_8_numeric-field_23' aria-label=\"What is the estimated fair market value of the property?\">What is the estimated fair market value of the property?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_23\" id=\"ff_8_numeric-field_23\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_23\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"136\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_25\"  class='ff-t-container ff-column-container ff_columns_total_2 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is this property currently in foreclosure?\">Is this property currently in foreclosure?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_22_ee8cda58cd619816fe11eea8cbed35b3'><input  type=\"radio\" name=\"input_radio_22\" data-name=\"input_radio_22\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"137\" value=\"yes\"  id='input_radio_22_ee8cda58cd619816fe11eea8cbed35b3' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_22_82a1dcdcff38dc36535734154d19420c'><input  type=\"radio\" name=\"input_radio_22\" data-name=\"input_radio_22\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_22_82a1dcdcff38dc36535734154d19420c' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_datetime_9' id='label_ff_8_datetime_9' aria-label=\"When is the scheduled Sheriff Sale?\">When is the scheduled Sheriff Sale?<\/label><\/div><div class='ff-el-input--content'><input  aria-label='When is the scheduled Sheriff Sale? Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_9\" id=\"ff_8_datetime_9\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_9\" tabindex=\"138\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_left\" data-name=\"section_break-8_13\" ><h3 class='ff-el-section-title'>Vehicles<\/h3><div class='ff-section_break_desk'><p>Primary Vehicle<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_26\"  class='ff-t-container ff-column-container ff_columns_total_3 Primary Vehicle has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_14' id='label_ff_8_input_text_14' aria-label=\"What is the model year?\">What is the model year?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_14\" class=\"ff-el-form-control\" placeholder=\"Ex: 2021\" data-name=\"input_text_14\" tabindex=\"139\" id=\"ff_8_input_text_14\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_15' id='label_ff_8_input_text_15' aria-label=\"What Make is the vehicle?\">What Make is the vehicle?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_15\" class=\"ff-el-form-control\" placeholder=\"Ex: Ford\" data-name=\"input_text_15\" tabindex=\"140\" id=\"ff_8_input_text_15\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_16' id='label_ff_8_input_text_16' aria-label=\"What model is the vehicle?\">What model is the vehicle?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_16\" class=\"ff-el-form-control\" placeholder=\"Ex: F-150\" data-name=\"input_text_16\" tabindex=\"141\" id=\"ff_8_input_text_16\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_27\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_24' id='label_ff_8_numeric-field_24' aria-label=\"Mileage:\">Mileage:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field_24\" id=\"ff_8_numeric-field_24\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"Ex: 20,000\" data-name=\"numeric-field_24\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"142\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is this a leased vehicle?\">Is this a leased vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_23_096bdc27524320d1103f063e5e240653'><input  type=\"radio\" name=\"input_radio_23\" data-name=\"input_radio_23\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"143\" value=\"yes\"  id='input_radio_23_096bdc27524320d1103f063e5e240653' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_23_4425d2198a9746e7cd460d284b95e17b'><input  type=\"radio\" name=\"input_radio_23\" data-name=\"input_radio_23\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_23_4425d2198a9746e7cd460d284b95e17b' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a lien on the vehicle?\">Is there a lien on the vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_24_cab2453ca7bd1369580aa7c3d82196de'><input  type=\"radio\" name=\"input_radio_24\" data-name=\"input_radio_24\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"144\" value=\"yes\"  id='input_radio_24_cab2453ca7bd1369580aa7c3d82196de' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_24_4ea1d0f85b09adf4a2f0bf421960a2a2'><input  type=\"radio\" name=\"input_radio_24\" data-name=\"input_radio_24\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_24_4ea1d0f85b09adf4a2f0bf421960a2a2' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_28\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_26' id='label_ff_8_numeric-field_26' aria-label=\"What is the monthly payment amount?\">What is the monthly payment amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_26\" id=\"ff_8_numeric-field_26\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_26\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"145\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are the payments current?\">Are the payments current?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_25_6c8c3aeeac1529688e06ce44ac2af175'><input  type=\"radio\" name=\"input_radio_25\" data-name=\"input_radio_25\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"146\" value=\"yes\"  id='input_radio_25_6c8c3aeeac1529688e06ce44ac2af175' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_25_d14b37f99d2b220578d89fba92c443fa'><input  type=\"radio\" name=\"input_radio_25\" data-name=\"input_radio_25\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_25_d14b37f99d2b220578d89fba92c443fa' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_dropdown_6' id='label_ff_8_dropdown_6' aria-label=\"How many months past due is it?\">How many months past due is it?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_6\" id=\"ff_8_dropdown_6\" class=\"ff-el-form-control\" data-name=\"dropdown_6\" data-calc_value=\"0\" tabindex=\"147\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_8_dropdown_6\"><option value=\"\">1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"4 or more\"  >4 or more<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_29\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you want to keep this vehicle?\">Do you want to keep this vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_26_f58d3ae8e1b6083c15e002a8b39f0d6c'><input  type=\"radio\" name=\"input_radio_26\" data-name=\"input_radio_26\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"148\" value=\"yes\"  id='input_radio_26_f58d3ae8e1b6083c15e002a8b39f0d6c' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_26_47dad11705c6d862cca8e830141d0e45'><input  type=\"radio\" name=\"input_radio_26\" data-name=\"input_radio_26\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_26_47dad11705c6d862cca8e830141d0e45' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a co-signor for this vehicle?\">Is there a co-signor for this vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_47_28850b49f3a34d5d8e27fffc7f129838'><input  type=\"radio\" name=\"input_radio_47\" data-name=\"input_radio_47\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"149\" value=\"yes\"  id='input_radio_47_28850b49f3a34d5d8e27fffc7f129838' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_47_c3796db136a9e97b09e9e5fc76eb55dc'><input  type=\"radio\" name=\"input_radio_47\" data-name=\"input_radio_47\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_47_c3796db136a9e97b09e9e5fc76eb55dc' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_25' id='label_ff_8_numeric-field_25' aria-label=\"What is the Estimated Payoff Amount?\">What is the Estimated Payoff Amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_25\" id=\"ff_8_numeric-field_25\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_25\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"150\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_left\" data-name=\"section_break-8_14\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p>Second Vehicle<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_30\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_17' id='label_ff_8_input_text_17' aria-label=\"What Make is the vehicle?\">What Make is the vehicle?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_17\" class=\"ff-el-form-control\" placeholder=\"Ex: Chevrolet\" data-name=\"input_text_17\" tabindex=\"151\" id=\"ff_8_input_text_17\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_18' id='label_ff_8_input_text_18' aria-label=\"What is the model year?\">What is the model year?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_18\" class=\"ff-el-form-control\" placeholder=\"Ex: 2006\" data-name=\"input_text_18\" tabindex=\"152\" id=\"ff_8_input_text_18\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_19' id='label_ff_8_input_text_19' aria-label=\"What model is the vehicle?\">What model is the vehicle?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_19\" class=\"ff-el-form-control\" placeholder=\"Ex: Monte Carlo\" data-name=\"input_text_19\" tabindex=\"153\" id=\"ff_8_input_text_19\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_31\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_27' id='label_ff_8_numeric-field_27' aria-label=\"Mileage:\">Mileage:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field_27\" id=\"ff_8_numeric-field_27\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"Ex: 120,000\" data-name=\"numeric-field_27\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"154\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is this a leased vehicle?\">Is this a leased vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_27_6f053c02fa340796559e13dbd2f90cd9'><input  type=\"radio\" name=\"input_radio_27\" data-name=\"input_radio_27\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"155\" value=\"yes\"  id='input_radio_27_6f053c02fa340796559e13dbd2f90cd9' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_27_4d61407c643113ededaf15e18b848399'><input  type=\"radio\" name=\"input_radio_27\" data-name=\"input_radio_27\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_27_4d61407c643113ededaf15e18b848399' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a lien on the vehicle?\">Is there a lien on the vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_28_724f70f4e749d2c52423de89825ed258'><input  type=\"radio\" name=\"input_radio_28\" data-name=\"input_radio_28\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"156\" value=\"yes\"  id='input_radio_28_724f70f4e749d2c52423de89825ed258' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_28_11d7ced7884072717db1f2afb225e54d'><input  type=\"radio\" name=\"input_radio_28\" data-name=\"input_radio_28\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_28_11d7ced7884072717db1f2afb225e54d' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_32\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_29' id='label_ff_8_numeric-field_29' aria-label=\"What is the monthly payment amount?\">What is the monthly payment amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_29\" id=\"ff_8_numeric-field_29\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_29\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"157\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are the payments current?\">Are the payments current?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_30_13f75c1d862fb79e8fe0206c3fffc9a9'><input  type=\"radio\" name=\"input_radio_30\" data-name=\"input_radio_30\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"158\" value=\"yes\"  id='input_radio_30_13f75c1d862fb79e8fe0206c3fffc9a9' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_30_dfbb423345cb0486f9859661d92578b3'><input  type=\"radio\" name=\"input_radio_30\" data-name=\"input_radio_30\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_30_dfbb423345cb0486f9859661d92578b3' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_dropdown_7' id='label_ff_8_dropdown_7' aria-label=\"How many months past due is it?\">How many months past due is it?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_7\" id=\"ff_8_dropdown_7\" class=\"ff-el-form-control\" data-name=\"dropdown_7\" data-calc_value=\"0\" tabindex=\"159\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_8_dropdown_7\"><option value=\"\">1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"4 or more\"  >4 or more<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_33\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you want to keep it?\">Do you want to keep it?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_29_dbfc57505f41d8da9913b8badbb4cce6'><input  type=\"radio\" name=\"input_radio_29\" data-name=\"input_radio_29\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"160\" value=\"yes\"  id='input_radio_29_dbfc57505f41d8da9913b8badbb4cce6' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_29_ab048c8a0f8292ec2a9bb9eb0afde3c0'><input  type=\"radio\" name=\"input_radio_29\" data-name=\"input_radio_29\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_29_ab048c8a0f8292ec2a9bb9eb0afde3c0' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a co-signor for this vehicle?\">Is there a co-signor for this vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_48_77af23d3cb7381e350667ce6501775fc'><input  type=\"radio\" name=\"input_radio_48\" data-name=\"input_radio_48\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"161\" value=\"yes\"  id='input_radio_48_77af23d3cb7381e350667ce6501775fc' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_48_be8d8f88fb3d6880efd5ce5f5bc6412c'><input  type=\"radio\" name=\"input_radio_48\" data-name=\"input_radio_48\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_48_be8d8f88fb3d6880efd5ce5f5bc6412c' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_28' id='label_ff_8_numeric-field_28' aria-label=\"What is the Estimated Payoff Amount?\">What is the Estimated Payoff Amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_28\" id=\"ff_8_numeric-field_28\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_28\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"162\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class=\"ff-el-group  has-conditions ff-el-section-break  ff_left\" data-name=\"section_break-8_15\" ><h3 class='ff-el-section-title'><\/h3><div class='ff-section_break_desk'><p>Third Vehicle<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_34\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_21' id='label_ff_8_input_text_21' aria-label=\"What is the model year?\">What is the model year?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_21\" class=\"ff-el-form-control\" placeholder=\"Ex: 2014\" data-name=\"input_text_21\" tabindex=\"163\" id=\"ff_8_input_text_21\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_20' id='label_ff_8_input_text_20' aria-label=\"What Make is the vehicle?\">What Make is the vehicle?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_20\" class=\"ff-el-form-control\" placeholder=\"Ex: Ford\" data-name=\"input_text_20\" tabindex=\"164\" id=\"ff_8_input_text_20\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_input_text_22' id='label_ff_8_input_text_22' aria-label=\"What model is the vehicle?\">What model is the vehicle?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_22\" class=\"ff-el-form-control\" placeholder=\"Ex: F-150\" data-name=\"input_text_22\" tabindex=\"165\" id=\"ff_8_input_text_22\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_35\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_30' id='label_ff_8_numeric-field_30' aria-label=\"Mileage:\">Mileage:<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field_30\" id=\"ff_8_numeric-field_30\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"Ex: 120,000\" data-name=\"numeric-field_30\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"166\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is this a leased vehicle?\">Is this a leased vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_31_839e7f04cc60372104579570e6057c12'><input  type=\"radio\" name=\"input_radio_31\" data-name=\"input_radio_31\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"167\" value=\"yes\"  id='input_radio_31_839e7f04cc60372104579570e6057c12' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_31_e2240a5066067b92d93a29b7c64e0607'><input  type=\"radio\" name=\"input_radio_31\" data-name=\"input_radio_31\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_31_e2240a5066067b92d93a29b7c64e0607' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a lien on the vehicle?\">Is there a lien on the vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_32_4c8251940ffa0041bf3b81c14b2446eb'><input  type=\"radio\" name=\"input_radio_32\" data-name=\"input_radio_32\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"168\" value=\"yes\"  id='input_radio_32_4c8251940ffa0041bf3b81c14b2446eb' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_32_6f316a88bd0c4b65e7e6c6e1a8b499e2'><input  type=\"radio\" name=\"input_radio_32\" data-name=\"input_radio_32\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_32_6f316a88bd0c4b65e7e6c6e1a8b499e2' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_36\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_31' id='label_ff_8_numeric-field_31' aria-label=\"What is the monthly payment amount?\">What is the monthly payment amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_31\" id=\"ff_8_numeric-field_31\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_31\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"169\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are the payments current?\">Are the payments current?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_33_cc6a0f57d150b9682c6f7432eb1d02ab'><input  type=\"radio\" name=\"input_radio_33\" data-name=\"input_radio_33\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"170\" value=\"yes\"  id='input_radio_33_cc6a0f57d150b9682c6f7432eb1d02ab' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_33_aec126d926e27a0be7d05539e6a47e3b'><input  type=\"radio\" name=\"input_radio_33\" data-name=\"input_radio_33\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_33_aec126d926e27a0be7d05539e6a47e3b' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_dropdown_8' id='label_ff_8_dropdown_8' aria-label=\"How many months past due is it?\">How many months past due is it?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_8\" id=\"ff_8_dropdown_8\" class=\"ff-el-form-control\" data-name=\"dropdown_8\" data-calc_value=\"0\" tabindex=\"171\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_8_dropdown_8\"><option value=\"\">1<\/option><option value=\"2\"  >2<\/option><option value=\"3\"  >3<\/option><option value=\"4 or more\"  >4 or more<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_37\"  class='ff-t-container ff-column-container ff_columns_total_3 has-conditions'><div class='ff-t-cell ff-t-column-1' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you want to keep it?\">Do you want to keep it?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_34_cd16de034d328d2f5fe7553e2d2c48d8'><input  type=\"radio\" name=\"input_radio_34\" data-name=\"input_radio_34\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"172\" value=\"yes\"  id='input_radio_34_cd16de034d328d2f5fe7553e2d2c48d8' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_34_de3fa49f899a5ceeab559e5251fd184d'><input  type=\"radio\" name=\"input_radio_34\" data-name=\"input_radio_34\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_34_de3fa49f899a5ceeab559e5251fd184d' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Is there a co-signor for this vehicle?\">Is there a co-signor for this vehicle?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_49_81362d89b4adfbbd6d0b198886cc9a67'><input  type=\"radio\" name=\"input_radio_49\" data-name=\"input_radio_49\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"173\" value=\"yes\"  id='input_radio_49_81362d89b4adfbbd6d0b198886cc9a67' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_49_3cde12f52fbe4fe195197b40eba5f8ea'><input  type=\"radio\" name=\"input_radio_49\" data-name=\"input_radio_49\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_49_3cde12f52fbe4fe195197b40eba5f8ea' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-3' style='flex-basis: 33.33%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_32' id='label_ff_8_numeric-field_32' aria-label=\"What is the Estimated Payoff Amount?\">What is the Estimated Payoff Amount?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_32\" id=\"ff_8_numeric-field_32\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_32\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"174\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_16\" ><p>If there are more than three vehicles in your household, that's okay. We will go over the others during your consultation.<\/p><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_dropdown_11' id='label_ff_8_dropdown_11' aria-label=\"How many recreational vehicles do you have (ATVs, boats, etc.)?\">How many recreational vehicles do you have (ATVs, boats, etc.)?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_11\" id=\"ff_8_dropdown_11\" class=\"ff-el-form-control\" data-name=\"dropdown_11\" data-calc_value=\"0\" tabindex=\"175\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_8_dropdown_11\"><option value=\"\">- Select -<\/option><option value=\"0\"  >0<\/option><option value=\"1\"  >1<\/option><option value=\"2\"  >2<\/option><option value=\"More than 2\"  >More than 2<\/option><\/select><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description' id='label_ff_8_description' aria-label=\"Please describe your recreational vehicles here:\">Please describe your recreational vehicles here:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description\" name=\"description\" id=\"ff_8_description\" class=\"ff-el-form-control\" placeholder=\"makes, models, model years and estimated fair market value\" rows=\"3\" cols=\"2\" data-name=\"description\" tabindex=\"176\" ><\/textarea><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_17\" ><h3 class='ff-el-section-title'>Household Items<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_1' id='label_ff_8_description_1' aria-label=\"Please describe the general types of household goods and furnishings you have ownership interest in (you don&#039;t have to list every item separately):\">Please describe the general types of household goods and furnishings you have ownership interest in (you don't have to list every item separately):<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_1\" name=\"description_1\" id=\"ff_8_description_1\" class=\"ff-el-form-control\" placeholder=\"Ex: Major appliances, furniture, linens, china, kitchenware. etc.\" rows=\"3\" cols=\"2\" data-name=\"description_1\" tabindex=\"177\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_33' id='label_ff_8_numeric-field_33' aria-label=\"What is the total current market value of your interest in the household goods and furnishings listed above?\">What is the total current market value of your interest in the household goods and furnishings listed above?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_33\" id=\"ff_8_numeric-field_33\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_33\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"178\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_2' id='label_ff_8_description_2' aria-label=\"Please describe the types of electronics you have ownership interest in (you don&#039;t have to list every item separately):\">Please describe the types of electronics you have ownership interest in (you don't have to list every item separately):<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_2\" name=\"description_2\" id=\"ff_8_description_2\" class=\"ff-el-form-control\" placeholder=\"Televisions, computers, smart phones, game systems, etc.\" rows=\"3\" cols=\"2\" data-name=\"description_2\" tabindex=\"179\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_34' id='label_ff_8_numeric-field_34' aria-label=\"What is the total current market value of your interest in the electronics listed above?\">What is the total current market value of your interest in the electronics listed above?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_34\" id=\"ff_8_numeric-field_34\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_34\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"180\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_3' id='label_ff_8_description_3' aria-label=\"Please describe your clothing (you don&#039;t have to list every item separately):\">Please describe your clothing (you don't have to list every item separately):<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_3\" name=\"description_3\" id=\"ff_8_description_3\" class=\"ff-el-form-control\" placeholder=\"Examples: Everyday clothes, furs, leather coats, designer wear, shoes, accessories\" rows=\"3\" cols=\"2\" data-name=\"description_3\" tabindex=\"181\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_36' id='label_ff_8_numeric-field_36' aria-label=\"What is the total current fair market value of all of your clothing?\">What is the total current fair market value of all of your clothing?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_36\" id=\"ff_8_numeric-field_36\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_36\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"182\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_4' id='label_ff_8_description_4' aria-label=\"Please describe your jewelry:\">Please describe your jewelry:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_4\" name=\"description_4\" id=\"ff_8_description_4\" class=\"ff-el-form-control\" placeholder=\"Examples: Everyday jewelry, watches, costume jewelry, engagement rings, wedding rings, heirloom jewelry, watches, gems, gold, silver\" rows=\"3\" cols=\"2\" data-name=\"description_4\" tabindex=\"183\" ><\/textarea><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_35' id='label_ff_8_numeric-field_35' aria-label=\"What is the total current fair market value of all of your jewelry?\">What is the total current fair market value of all of your jewelry?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_35\" id=\"ff_8_numeric-field_35\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_35\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"184\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Please select all items in which you have an ownership interest:\">Please select all items in which you have an ownership interest:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_64f2703de2a67d1502b59f28a766f397'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"185\" value=\"Collectibles (coins, comic books, art, etc.)\"  id='checkbox_4_64f2703de2a67d1502b59f28a766f397' aria-label='Collectibles (coins, comic books, art, etc.)' aria-invalid='false' aria-required=false> <span>Collectibles (coins, comic books, art, etc.)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_7a766fc4e4a5a3bba69902bbcdb40426'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Sports or hobby equipment (hockey gear, camping gear, etc.)\"  id='checkbox_4_7a766fc4e4a5a3bba69902bbcdb40426' aria-label='Sports or hobby equipment (hockey gear, camping gear, etc.)' aria-invalid='false' aria-required=false> <span>Sports or hobby equipment (hockey gear, camping gear, etc.)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_4d9c748e6da45b42ebcd8f9877ef8fc8'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Firearms (hunting rifles, handguns, etc.)\"  id='checkbox_4_4d9c748e6da45b42ebcd8f9877ef8fc8' aria-label='Firearms (hunting rifles, handguns, etc.)' aria-invalid='false' aria-required=false> <span>Firearms (hunting rifles, handguns, etc.)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_39ddae6fad939e3bcf434621bf055255'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Animals (including house pets)\"  id='checkbox_4_39ddae6fad939e3bcf434621bf055255' aria-label='Animals (including house pets)' aria-invalid='false' aria-required=false> <span>Animals (including house pets)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_4_0fba0ecc71484886a21bb88409009d8f'><input  type=\"checkbox\" name=\"checkbox_4[]\" data-name=\"checkbox_4\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Personal health aids (hearing aids, mobility scooters, etc.)\"  id='checkbox_4_0fba0ecc71484886a21bb88409009d8f' aria-label='Personal health aids (hearing aids, mobility scooters, etc.)' aria-invalid='false' aria-required=false> <span>Personal health aids (hearing aids, mobility scooters, etc.)<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_8' id='label_ff_8_description_8' aria-label=\"Please describe the nature or type of your collectibles:\">Please describe the nature or type of your collectibles:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_8\" name=\"description_8\" id=\"ff_8_description_8\" class=\"ff-el-form-control\" placeholder=\"Examples: Rare coins, baseball cards, comic books, figurines, art, valuable antiques, etc.)\" rows=\"3\" cols=\"2\" data-name=\"description_8\" tabindex=\"186\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_92' id='label_ff_8_numeric-field_92' aria-label=\"What is the total current fair market value of all of your collectibles?\">What is the total current fair market value of all of your collectibles?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_92\" id=\"ff_8_numeric-field_92\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_92\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"187\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_12' id='label_ff_8_description_12' aria-label=\"Please describe your sports or hobby equipment:\">Please describe your sports or hobby equipment:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_12\" name=\"description_12\" id=\"ff_8_description_12\" class=\"ff-el-form-control\" placeholder=\"Examples: hockey gear, kayak, camping equipment, etc.)\" rows=\"3\" cols=\"2\" data-name=\"description_12\" tabindex=\"188\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_93' id='label_ff_8_numeric-field_93' aria-label=\"What is the total current fair market value of all of your sports or hobby equipment?\">What is the total current fair market value of all of your sports or hobby equipment?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_93\" id=\"ff_8_numeric-field_93\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_93\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"189\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_11' id='label_ff_8_description_11' aria-label=\"Please describe your firearms:\">Please describe your firearms:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_11\" name=\"description_11\" id=\"ff_8_description_11\" class=\"ff-el-form-control\" placeholder=\"Examples: Hunting rifles, handguns, etc.)\" rows=\"3\" cols=\"2\" data-name=\"description_11\" tabindex=\"190\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_94' id='label_ff_8_numeric-field_94' aria-label=\"What is the total current fair market value of all of your firearms?\">What is the total current fair market value of all of your firearms?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"numeric-field_94\" id=\"ff_8_numeric-field_94\" class=\"ff-el-form-control  ff_numeric\" data-name=\"numeric-field_94\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"191\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_10' id='label_ff_8_description_10' aria-label=\"Please describe your animals:\">Please describe your animals:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_10\" name=\"description_10\" id=\"ff_8_description_10\" class=\"ff-el-form-control\" placeholder=\"Examples: Dogs, cats, etc.)\" rows=\"3\" cols=\"2\" data-name=\"description_10\" tabindex=\"192\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_95' id='label_ff_8_numeric-field_95' aria-label=\"What is the total current fair market value of all of your animals?\">What is the total current fair market value of all of your animals?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_95\" id=\"ff_8_numeric-field_95\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_95\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"193\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_9' id='label_ff_8_description_9' aria-label=\"Personal health aids:\">Personal health aids:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_9\" name=\"description_9\" id=\"ff_8_description_9\" class=\"ff-el-form-control\" placeholder=\"Examples: hearing aids, mobility scooters, etc.)\" rows=\"3\" cols=\"2\" data-name=\"description_9\" tabindex=\"194\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_96' id='label_ff_8_numeric-field_96' aria-label=\"What is the total current fair market value of all of your personal health aids?\">What is the total current fair market value of all of your personal health aids?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_96\" id=\"ff_8_numeric-field_96\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_96\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"195\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you have any ownership interest in any other household items not already listed above?\">Do you have any ownership interest in any other household items not already listed above?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_35_4b7603530494cf12fc90da2cfba73d5b'><input  type=\"radio\" name=\"input_radio_35\" data-name=\"input_radio_35\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"196\" value=\"yes\"  id='input_radio_35_4b7603530494cf12fc90da2cfba73d5b' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_35_d4807b7e2d7913656b7c47430254cbba'><input  type=\"radio\" name=\"input_radio_35\" data-name=\"input_radio_35\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_35_d4807b7e2d7913656b7c47430254cbba' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_5' id='label_ff_8_description_5' aria-label=\"Describe any other household items you have an ownership interest in not already listed:\">Describe any other household items you have an ownership interest in not already listed:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_5\" name=\"description_5\" id=\"ff_8_description_5\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_5\" tabindex=\"197\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_37' id='label_ff_8_numeric-field_37' aria-label=\"What is the total fair market value of these other items?\">What is the total fair market value of these other items?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_37\" id=\"ff_8_numeric-field_37\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_37\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"198\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_18\" ><h3 class='ff-el-section-title'>Financial Assets<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Please indicate whether you own or have a partial interest in any of the following:\">Please indicate whether you own or have a partial interest in any of the following:<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_8cf8daa4a528370eebfede24511ec369'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"199\" value=\"Cash on hand (money in your wallet or at home)\"  id='checkbox_5_8cf8daa4a528370eebfede24511ec369' aria-label='Cash on hand (money in your wallet or at home)' aria-invalid='false' aria-required=false> <span>Cash on hand (money in your wallet or at home)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_5444fc0cd1bf1ef2aabfdaac1c06a284'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Bank accounts (checking, savings, or prepaid debit cards\"  id='checkbox_5_5444fc0cd1bf1ef2aabfdaac1c06a284' aria-label='Bank accounts (checking, savings, or prepaid debit cards' aria-invalid='false' aria-required=false> <span>Bank accounts (checking, savings, or prepaid debit cards<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_0304cb08fd68d2b645c954eeb067da6b'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Checks payable to you, but not yet deposited\"  id='checkbox_5_0304cb08fd68d2b645c954eeb067da6b' aria-label='Checks payable to you, but not yet deposited' aria-invalid='false' aria-required=false> <span>Checks payable to you, but not yet deposited<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_16b9620b8a663a158976e5173b21ef1e'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Stocks, bonds, or mutual funds\"  id='checkbox_5_16b9620b8a663a158976e5173b21ef1e' aria-label='Stocks, bonds, or mutual funds' aria-invalid='false' aria-required=false> <span>Stocks, bonds, or mutual funds<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_b9eb17fe32a07f796bc24d9bcb5f82e9'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Individual Retirement Accounts (IRAs)\"  id='checkbox_5_b9eb17fe32a07f796bc24d9bcb5f82e9' aria-label='Individual Retirement Accounts (IRAs)' aria-invalid='false' aria-required=false> <span>Individual Retirement Accounts (IRAs)<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_7d980a3ed7e4fb2ceebf024215ae6531'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Education IRAs\"  id='checkbox_5_7d980a3ed7e4fb2ceebf024215ae6531' aria-label='Education IRAs' aria-invalid='false' aria-required=false> <span>Education IRAs<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_bf741243fe1ca57924087561c6103631'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Retirement or pension accounts\"  id='checkbox_5_bf741243fe1ca57924087561c6103631' aria-label='Retirement or pension accounts' aria-invalid='false' aria-required=false> <span>Retirement or pension accounts<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_24962d9654c80fd29c6bc497d0a48cbb'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Annuities\"  id='checkbox_5_24962d9654c80fd29c6bc497d0a48cbb' aria-label='Annuities' aria-invalid='false' aria-required=false> <span>Annuities<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_a84818aa0eec8c6250c7ec4052b2e717'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Government or corporate bonds\"  id='checkbox_5_a84818aa0eec8c6250c7ec4052b2e717' aria-label='Government or corporate bonds' aria-invalid='false' aria-required=false> <span>Government or corporate bonds<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_69a30caba82dfd08aa02b5819795b2d2'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Any shares or partnership interests in any business\"  id='checkbox_5_69a30caba82dfd08aa02b5819795b2d2' aria-label='Any shares or partnership interests in any business' aria-invalid='false' aria-required=false> <span>Any shares or partnership interests in any business<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_677de2b62c8c23dc078f09896a10aef6'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Security deposits or prepayments\"  id='checkbox_5_677de2b62c8c23dc078f09896a10aef6' aria-label='Security deposits or prepayments' aria-invalid='false' aria-required=false> <span>Security deposits or prepayments<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_584db21ae530779b2e6db2246401d558'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Trusts\"  id='checkbox_5_584db21ae530779b2e6db2246401d558' aria-label='Trusts' aria-invalid='false' aria-required=false> <span>Trusts<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_867723d501a557e9627d7aa6c091e92b'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Patents, copyrights, intellectual property rights\"  id='checkbox_5_867723d501a557e9627d7aa6c091e92b' aria-label='Patents, copyrights, intellectual property rights' aria-invalid='false' aria-required=false> <span>Patents, copyrights, intellectual property rights<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_2089fca8550721e385c1c1e540a4a7ef'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Licenses, franchises, building permits\"  id='checkbox_5_2089fca8550721e385c1c1e540a4a7ef' aria-label='Licenses, franchises, building permits' aria-invalid='false' aria-required=false> <span>Licenses, franchises, building permits<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_5_30012eac878b6edb52c363e8f940dba9'><input  type=\"checkbox\" name=\"checkbox_5[]\" data-name=\"checkbox_5\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Any farm or commercial fishing related property\"  id='checkbox_5_30012eac878b6edb52c363e8f940dba9' aria-label='Any farm or commercial fishing related property' aria-invalid='false' aria-required=false> <span>Any farm or commercial fishing related property<\/span><\/label><\/div><\/div><\/div><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_19\" ><h3 class='ff-el-section-title'>Money or Property Owed to You<\/h3><div class='ff-section_break_desk'><\/div><hr \/><\/div><div data-name=\"ff_cn_id_38\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are you expecting a tax refund for the current year?\">Are you expecting a tax refund for the current year?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_36_e6b4e41b66744f6e6dcb443deaaf2fe6'><input  type=\"radio\" name=\"input_radio_36\" data-name=\"input_radio_36\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"200\" value=\"yes\"  id='input_radio_36_e6b4e41b66744f6e6dcb443deaaf2fe6' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_36_b30db2d94aec38e1ea29dbeda707d2de'><input  type=\"radio\" name=\"input_radio_36\" data-name=\"input_radio_36\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_36_b30db2d94aec38e1ea29dbeda707d2de' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_97' id='label_ff_8_numeric-field_97' aria-label=\"How much are you expecting?\">How much are you expecting?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_97\" id=\"ff_8_numeric-field_97\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_97\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"201\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_39\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are you owed any past due family support? (Ex: past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement)\">Are you owed any past due family support? (Ex: past due or lump sum alimony, spousal support, child support, maintenance, divorce settlement, property settlement)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_37_4419a1d66ddf12542e6d1a91b5c28b80'><input  type=\"radio\" name=\"input_radio_37\" data-name=\"input_radio_37\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"202\" value=\"yes\"  id='input_radio_37_4419a1d66ddf12542e6d1a91b5c28b80' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_37_617a45ab0ed95158b752b64503d50aa6'><input  type=\"radio\" name=\"input_radio_37\" data-name=\"input_radio_37\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_37_617a45ab0ed95158b752b64503d50aa6' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_100' id='label_ff_8_numeric-field_100' aria-label=\"How much are you owed in family support?\">How much are you owed in family support?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_100\" id=\"ff_8_numeric-field_100\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_100\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"203\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_40\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are there any amounts someone owes you? (Ex:  unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers\u2019 compensation, Social Security benefits; unpaid loans you made to someone else)\">Are there any amounts someone owes you? (Ex:  unpaid wages, disability insurance payments, disability benefits, sick pay, vacation pay, workers\u2019 compensation, Social Security benefits; unpaid loans you made to someone else)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_38_d431f395792a551068a2edb73c14a6f4'><input  type=\"radio\" name=\"input_radio_38\" data-name=\"input_radio_38\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"204\" value=\"yes\"  id='input_radio_38_d431f395792a551068a2edb73c14a6f4' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_38_267f85efadc099a046c164c9177d3c5f'><input  type=\"radio\" name=\"input_radio_38\" data-name=\"input_radio_38\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_38_267f85efadc099a046c164c9177d3c5f' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_99' id='label_ff_8_numeric-field_99' aria-label=\"How much do they owe you?\">How much do they owe you?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_99\" id=\"ff_8_numeric-field_99\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_99\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"205\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_41\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you have any interests in insurance policies? (Ex: : Health, disability, or life insurance; health savings account (HSA); credit, homeowner\u2019s, or renter\u2019s insurance)\">Do you have any interests in insurance policies? (Ex: : Health, disability, or life insurance; health savings account (HSA); credit, homeowner\u2019s, or renter\u2019s insurance)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_39_3763fa1649ae3d8b1fe7314bb8a966f8'><input  type=\"radio\" name=\"input_radio_39\" data-name=\"input_radio_39\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"206\" value=\"yes\"  id='input_radio_39_3763fa1649ae3d8b1fe7314bb8a966f8' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_39_bc07770d8d723b53e00dc7ee8dc75527'><input  type=\"radio\" name=\"input_radio_39\" data-name=\"input_radio_39\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_39_bc07770d8d723b53e00dc7ee8dc75527' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_101' id='label_ff_8_numeric-field_101' aria-label=\"What is the total value of your insurance policies?\">What is the total value of your insurance policies?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_101\" id=\"ff_8_numeric-field_101\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_101\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"207\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_42\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you have any interest in property that is due you from someone who has died?\">Do you have any interest in property that is due you from someone who has died?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_40_d30332c56dbe911568b438469cdce9a4'><input  type=\"radio\" name=\"input_radio_40\" data-name=\"input_radio_40\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"208\" value=\"yes\"  id='input_radio_40_d30332c56dbe911568b438469cdce9a4' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_40_1538e86727ea11aed690f25fb0fc996a'><input  type=\"radio\" name=\"input_radio_40\" data-name=\"input_radio_40\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_40_1538e86727ea11aed690f25fb0fc996a' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_102' id='label_ff_8_numeric-field_102' aria-label=\"Our condolences for your loss. How much are you expecting?\">Our condolences for your loss. How much are you expecting?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_102\" id=\"ff_8_numeric-field_102\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_102\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"209\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_43\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Claims against third parties, whether or not you have filed a lawsuit or made a demand for payment? (Ex: accidents, employment disputes, insurance claims, or rights to sue)\">Claims against third parties, whether or not you have filed a lawsuit or made a demand for payment? (Ex: accidents, employment disputes, insurance claims, or rights to sue)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_41_a699a6a2b069aae418fba55e4c424a5c'><input  type=\"radio\" name=\"input_radio_41\" data-name=\"input_radio_41\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"210\" value=\"yes\"  id='input_radio_41_a699a6a2b069aae418fba55e4c424a5c' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_41_6c1505829daa246e4b46b270f3c0261d'><input  type=\"radio\" name=\"input_radio_41\" data-name=\"input_radio_41\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_41_6c1505829daa246e4b46b270f3c0261d' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_103' id='label_ff_8_numeric-field_103' aria-label=\"What is the total value of these claims?\">What is the total value of these claims?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_103\" id=\"ff_8_numeric-field_103\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_103\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"211\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_44\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Are there any other contingent and unliquidated claims of any nature, including counterclaims and rights to set off claims in which you know you have an interest?\">Are there any other contingent and unliquidated claims of any nature, including counterclaims and rights to set off claims in which you know you have an interest?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_42_3afed5a31527fc5d87dcfc74f6093b14'><input  type=\"radio\" name=\"input_radio_42\" data-name=\"input_radio_42\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"212\" value=\"yes\"  id='input_radio_42_3afed5a31527fc5d87dcfc74f6093b14' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_42_806ed7056ea264b22e0082c824e3de9a'><input  type=\"radio\" name=\"input_radio_42\" data-name=\"input_radio_42\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_42_806ed7056ea264b22e0082c824e3de9a' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_104' id='label_ff_8_numeric-field_104' aria-label=\"What is the total value of these claims?\">What is the total value of these claims?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_104\" id=\"ff_8_numeric-field_104\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_104\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"213\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_45\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"Do you have any other assets not already mentioned?\">Do you have any other assets not already mentioned?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_43_dc336e3ebf819d4e3be9bf15919d44eb'><input  type=\"radio\" name=\"input_radio_43\" data-name=\"input_radio_43\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"214\" value=\"yes\"  id='input_radio_43_dc336e3ebf819d4e3be9bf15919d44eb' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_43_2ba871db10c5052578edb3e941a3dc14'><input  type=\"radio\" name=\"input_radio_43\" data-name=\"input_radio_43\" class=\"ff-el-form-check-input ff-el-form-check-radio\" tabindex=\"-1\" value=\"no\"  id='input_radio_43_2ba871db10c5052578edb3e941a3dc14' aria-label='No' aria-invalid='false' aria-required=false> <span>No<\/span><\/label><\/div><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_6' id='label_ff_8_description_6' aria-label=\"Please describe the other assets not previously mentioned:\">Please describe the other assets not previously mentioned:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_6\" name=\"description_6\" id=\"ff_8_description_6\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_6\" tabindex=\"215\" ><\/textarea><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_105' id='label_ff_8_numeric-field_105' aria-label=\"What is the total fair market value of these other assets?\">What is the total fair market value of these other assets?<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_105\" id=\"ff_8_numeric-field_105\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_105\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"216\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;' tabindex='217'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;' tabindex='218'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_20\" ><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_21\" ><h3 class='ff-el-section-title'>Your Debts<\/h3><div class='ff-section_break_desk'><p>We will acquire your credit reports for more specific information later, but please provide just a rough overview of your debts with a general estimate of how much you allegedly owe by type.<\/p><\/div><hr \/><\/div><div data-name=\"ff_cn_id_46\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label   aria-label=\"What kinds or unsecured debts do you owe?\">What kinds or unsecured debts do you owe?<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_dd54cb05d3257b7700f0c395d21c5f3e'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"219\" value=\"Credit cards\"  id='checkbox_2_dd54cb05d3257b7700f0c395d21c5f3e' aria-label='Credit cards' aria-invalid='false' aria-required=false> <span>Credit cards<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_abb50284bd8d2c7a9656b12ed3f9ef02'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Medical bills\"  id='checkbox_2_abb50284bd8d2c7a9656b12ed3f9ef02' aria-label='Medical bills' aria-invalid='false' aria-required=false> <span>Medical bills<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_3d8133b57cd387888d8f2c860cec60a8'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Personal loans\"  id='checkbox_2_3d8133b57cd387888d8f2c860cec60a8' aria-label='Personal loans' aria-invalid='false' aria-required=false> <span>Personal loans<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_9439dbea37d78583cbd3da1e0e68aeb3'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Cash advances \/ payday loans\"  id='checkbox_2_9439dbea37d78583cbd3da1e0e68aeb3' aria-label='Cash advances \/ payday loans' aria-invalid='false' aria-required=false> <span>Cash advances \/ payday loans<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_189a977cdacdebb5163ba2152655c810'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Repossession deficiency balances\"  id='checkbox_2_189a977cdacdebb5163ba2152655c810' aria-label='Repossession deficiency balances' aria-invalid='false' aria-required=false> <span>Repossession deficiency balances<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_0aea8d58f0380b2748139a1bb322f508'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Lease termination balances\"  id='checkbox_2_0aea8d58f0380b2748139a1bb322f508' aria-label='Lease termination balances' aria-invalid='false' aria-required=false> <span>Lease termination balances<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_e87fb20663c49b64182e55359e4f6a33'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Foreclosure deficiency balances\"  id='checkbox_2_e87fb20663c49b64182e55359e4f6a33' aria-label='Foreclosure deficiency balances' aria-invalid='false' aria-required=false> <span>Foreclosure deficiency balances<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_3f65cea4dfcf6a8ea468b0aa8d6aa300'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Eviction costs\"  id='checkbox_2_3f65cea4dfcf6a8ea468b0aa8d6aa300' aria-label='Eviction costs' aria-invalid='false' aria-required=false> <span>Eviction costs<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_ea616fd31776da5d316f15ef793bd0a5'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Utilities past due:\"  id='checkbox_2_ea616fd31776da5d316f15ef793bd0a5' aria-label='Utilities past due:' aria-invalid='false' aria-required=false> <span>Utilities past due:<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_85b1b2b4f647f22d5af0c89cd2d62ef6'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Lawsuits \/ civil judgments\"  id='checkbox_2_85b1b2b4f647f22d5af0c89cd2d62ef6' aria-label='Lawsuits \/ civil judgments' aria-invalid='false' aria-required=false> <span>Lawsuits \/ civil judgments<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_d26f4d7a0aa1590ee06c574e151c98e8'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Taxes or government held debts\"  id='checkbox_2_d26f4d7a0aa1590ee06c574e151c98e8' aria-label='Taxes or government held debts' aria-invalid='false' aria-required=false> <span>Taxes or government held debts<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_26f861b10214098bb29d1695b1db7b00'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Student loans\"  id='checkbox_2_26f861b10214098bb29d1695b1db7b00' aria-label='Student loans' aria-invalid='false' aria-required=false> <span>Student loans<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_fa5a337c5912cefa7b1e7e8b1580e4f6'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Family support obligations\"  id='checkbox_2_fa5a337c5912cefa7b1e7e8b1580e4f6' aria-label='Family support obligations' aria-invalid='false' aria-required=false> <span>Family support obligations<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_f7fe8b7bcffc5552f8ccfd820398a915'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" tabindex=\"-1\" value=\"Other\"  id='checkbox_2_f7fe8b7bcffc5552f8ccfd820398a915' aria-label='Other' aria-invalid='false' aria-required=false> <span>Other<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_description_7' id='label_ff_8_description_7' aria-label=\"Please describe the general nature of the other debt you owe:\">Please describe the general nature of the other debt you owe:<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_8_description_7\" name=\"description_7\" id=\"ff_8_description_7\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description_7\" tabindex=\"220\" ><\/textarea><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_60' id='label_ff_8_numeric-field_60' aria-label=\"Total credit card debt:\">Total credit card debt:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_60\" id=\"ff_8_numeric-field_60\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_60\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"221\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_71' id='label_ff_8_numeric-field_71' aria-label=\"Total medical debt:\">Total medical debt:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_71\" id=\"ff_8_numeric-field_71\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_71\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"222\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_70' id='label_ff_8_numeric-field_70' aria-label=\"Total personal loan debt:\">Total personal loan debt:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_70\" id=\"ff_8_numeric-field_70\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_70\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"223\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_69' id='label_ff_8_numeric-field_69' aria-label=\"Total owed for cash advances or payday loans\">Total owed for cash advances or payday loans<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_69\" id=\"ff_8_numeric-field_69\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_69\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"224\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_68' id='label_ff_8_numeric-field_68' aria-label=\"Total repossession deficiencies:\">Total repossession deficiencies:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_68\" id=\"ff_8_numeric-field_68\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_68\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"225\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_67' id='label_ff_8_numeric-field_67' aria-label=\"Lease termination balance:\">Lease termination balance:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_67\" id=\"ff_8_numeric-field_67\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_67\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"226\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_65' id='label_ff_8_numeric-field_65' aria-label=\"Foreclosure deficiency amount:\">Foreclosure deficiency amount:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_65\" id=\"ff_8_numeric-field_65\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_65\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"227\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_66' id='label_ff_8_numeric-field_66' aria-label=\"Total eviction costs:\">Total eviction costs:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_66\" id=\"ff_8_numeric-field_66\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_66\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"228\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_72' id='label_ff_8_numeric-field_72' aria-label=\"Total past due utilities\">Total past due utilities <\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_72\" id=\"ff_8_numeric-field_72\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_72\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"229\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_64' id='label_ff_8_numeric-field_64' aria-label=\"Lawsuits \/ judgment amounts:\">Lawsuits \/ judgment amounts:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_64\" id=\"ff_8_numeric-field_64\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_64\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"230\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_63' id='label_ff_8_numeric-field_63' aria-label=\"Total taxes and government debts:\">Total taxes and government debts:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_63\" id=\"ff_8_numeric-field_63\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_63\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"231\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_62' id='label_ff_8_numeric-field_62' aria-label=\"Total student loans:\">Total student loans:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_62\" id=\"ff_8_numeric-field_62\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_62\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"232\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_61' id='label_ff_8_numeric-field_61' aria-label=\"Family support amount past due:\">Family support amount past due:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_61\" id=\"ff_8_numeric-field_61\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_61\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"233\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-el-group has-conditions'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_numeric-field_73' id='label_ff_8_numeric-field_73' aria-label=\"Total other debts:\">Total other debts:<\/label><\/div><div class='ff-el-input--content'><div class=\"ff_input-group\"><div class=\"ff_input-group-prepend\"><span class=\"ff_input-group-text\">$<\/span><\/div><input type=\"text\" name=\"numeric-field_73\" id=\"ff_8_numeric-field_73\" class=\"ff-el-form-control  ff_numeric\" placeholder=\"enter amount\" data-name=\"numeric-field_73\" inputmode=\"numeric\" step=\"any\" data-formatter=\"{&quot;decimal&quot;:&quot;.&quot;,&quot;separator&quot;:&quot;,&quot;,&quot;precision&quot;:2,&quot;symbol&quot;:&quot;&quot;}\" tabindex=\"234\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_22\" ><p>Please enter the name and last known address for the recipient of the family support you owe:<\/p><\/div><div data-type=\"name-element\" data-name=\"names_2\" class=\"has-conditions  ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_names_2_first_name_' id='label_ff_8_names_2_first_name_' >First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[first_name]\" id=\"ff_8_names_2_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" tabindex=\"235\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_names_2_middle_name_' id='label_ff_8_names_2_middle_name_' >Middle Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[middle_name]\" id=\"ff_8_names_2_middle_name_\" class=\"ff-el-form-control\" placeholder=\"Middle Name\" tabindex=\"236\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_names_2_last_name_' id='label_ff_8_names_2_last_name_' >Last Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_2[last_name]\" id=\"ff_8_names_2_last_name_\" class=\"ff-el-form-control\" placeholder=\"Last Name\" tabindex=\"237\" aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address has-conditions\" data-type=\"address-element\" data-name=\"address5\" ><div class='ff-el-input--label'><label aria-label=\"Last known address of your family support recipient:\">Last known address of your family support recipient:<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address5_address_line_1_' id='label_ff_8_address5_address_line_1_' aria-label=\"Address Line 1\">Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address5[address_line_1]\" id=\"ff_8_address5_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\" tabindex=\"238\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address5_address_line_2_' id='label_ff_8_address5_address_line_2_' aria-label=\"Address Line 2\">Address Line 2<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address5[address_line_2]\" id=\"ff_8_address5_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Address Line 2\" data-key_name=\"address_line_2\" tabindex=\"239\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address5_city_' id='label_ff_8_address5_city_' aria-label=\"City\">City<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address5[city]\" id=\"ff_8_address5_city_\" class=\"ff-el-form-control\" placeholder=\"City\" data-key_name=\"city\" tabindex=\"240\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address5_state_' id='label_ff_8_address5_state_' aria-label=\"State\">State<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address5[state]\" id=\"ff_8_address5_state_\" class=\"ff-el-form-control\" placeholder=\"Michigan\" data-key_name=\"state\" tabindex=\"241\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_8_address5_zip_' id='label_ff_8_address5_zip_' aria-label=\"Zip Code\">Zip Code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address5[zip]\" id=\"ff_8_address5_zip_\" class=\"ff-el-form-control\" placeholder=\"Zip\" data-key_name=\"zip\" tabindex=\"242\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;' tabindex='243'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;' tabindex='244'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-8_23\" ><div class=\"ff-el-group ff-el-section-break  ff_left\" data-name=\"section_break-8_24\" ><h3 class='ff-el-section-title'>Your Customized Required Documents List<\/h3><div class='ff-section_break_desk'><p>From the information you provided in this form, it appears that we will need copies of the following documents from you prior to filing any bankruptcy case (we will also email this list to you with instructions for collecting them and submitting them):<\/p><\/div><hr \/><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_25\" ><ul>\n<li>Driver's license (or other state-issued photo identification)<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_26\" ><ul>\n<li>Social Security card (or W-2 or 1099 with your Social Security Number clearly visible)\n<ul>\n<li>You can order a duplicate card if needed through the <a href=\"https:\/\/www.ssa.gov\/myaccount\/replacement-card.html\" target=\"_blank\" rel=\"noopener\">Social Security Administration<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_27\" ><ul>\n<li>Two most recent state and federal income tax returns (with all statements and schedules attached).\n<ul>\n<li>You can order tax return transcripts from the IRS here if you don't have copies of the returns: <a href=\"https:\/\/www.irs.gov\/individuals\/get-transcript\" target=\"_blank\" rel=\"noopener\">Internal Revenue Service transcripts<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_28\" ><ul>\n<li>Verification of all household income for the previous six months:<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_29\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Employment pay stubs<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_30\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Employment pay stubs for your spouse (whether filing for bankruptcy individually or jointly)<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_31\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Monthly Profit &amp; Loss statements for your business<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_32\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Unemployment benefit determination letter or payment history\n<ul>\n<li>You can get it here: <a href=\"https:\/\/www.michigan.gov\/leo\/0,5863,7-336-94422_97241_89980_90204_93126-365859--,00.html\" target=\"_blank\" rel=\"noopener\">Michigan WiWAM<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_33\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Family Support Order<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_34\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Public assistance benefit determination notice or verification letter<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_35\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Worker's Compensation determination or verification letter<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_36\" ><ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li>Social Security Benefit Verification Letter\n<ul>\n<li>You can get it here: <a href=\"https:\/\/www.ssa.gov\/myaccount\/proof-of-benefits.html\" target=\"_blank\" rel=\"noopener\">Social Security Administration<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_37\" ><ul>\n<li>Most recent statements for all mortgages and\/or real property liens<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_38\" ><ul>\n<li>Vehicle titles for all vehicles you have any ownership interest in\n<ul>\n<li>You can get duplicate titles here: <a href=\"https:\/\/dsvsesvc.sos.state.mi.us\/TAP\/_\/#1\" target=\"_blank\" rel=\"noopener\">Michigan Secretary of State online services<\/a><\/li>\n<\/ul>\n<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_39\" ><ul>\n<li>Most recent vehicle payment statement showing the monthly payment amount and balance owed<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_40\" ><ul>\n<li>Car Insurance Declarations Page, which you can get from your car insurance provider\u00a0(NOT the Certificate of Insurance normally carried in your car or wallet)<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_41\" ><ul>\n<li>Most recent statements for your 401k accounts, IRAs, stock holdings, mutual funds, or other investment accounts<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html has-conditions' tabindex='-1' data-name=\"custom_html-8_42\" ><ul>\n<li>Residential Lease Agreement<\/li>\n<\/ul><\/div><div class='ff-el-group  ff-custom_html' tabindex='-1' data-name=\"custom_html-8_43\" ><ul>\n<li>While we always acquire credit reports for our clients prior to filing a bankruptcy case, we do still recommend submitting your most recent statement from each of your known creditors.<\/li>\n<\/ul><\/div><div class='ff-el-group    ff-el-input--content'><div class='ff-el-form-check ff-el-tc'><label aria-label='Terms and Conditions: I acknowledge that the information I am providing through this form will be used to facilitate an initial review of my financial condition by the attorney with whom I intend to meet for a free consultation. I understand the attorney is relying on the information provided here and during the consultation to assess my legal options to manage or eliminate my debt and that this endeavor is best facilitated by providing complete and accurate information here and in all other communications with an attorney who represents me. I understand that I am ultimately responsible for the validity and accuracy of the information provided in communications with the Law Offices of J. L. Haddock, PLLC and that no attorney-client relationship exists with the firm or any member of the firm without a mutually signed Contract for Legal Representation.\nI understand accept the Terms and Conditions and the Disclaimer for the use of this website.\nWe are a debt relief agency proudly helping Michigan residents exercise their right to file for relief under the United States Bankruptcy Code and the protections it provides. Contains 2 links. Use tab navigation to review.' class='ff-el-form-check-label ff_tc_label' for=terms-n-condition_aab29dcabedcfe73adc86e313f0c9636><span class='ff_tc_checkbox'><input type=\"checkbox\" name=\"terms-n-condition\" class=\"ff-el-form-check-input\" data-name=\"terms-n-condition\" id=\"terms-n-condition_aab29dcabedcfe73adc86e313f0c9636\" tabindex=\"245\"  value='on' aria-invalid='false' aria-required=true><\/span> <div class='ff_t_c'><p>I acknowledge that the information I am providing through this form will be used to facilitate an initial review of my financial condition by the attorney with whom I intend to meet for a free consultation. I understand the attorney is relying on the information provided here and during the consultation to assess my legal options to manage or eliminate my debt and that this endeavor is best facilitated by providing complete and accurate information here and in all other communications with an attorney who represents me. I understand that I am ultimately responsible for the validity and accuracy of the information provided in communications with the Law Offices of J. L. Haddock, PLLC and that no attorney-client relationship exists with the firm or any member of the firm without a mutually signed Contract for Legal Representation.<\/p>\n<p>I understand accept the <a href=\"https:\/\/www.jlhaddock.com\/terms-and-conditions\/\" target=\"_blank\" rel=\"noopener\">Terms and Conditions<\/a> and the <a href=\"https:\/\/www.jlhaddock.com\/disclaimer\" target=\"_blank\" rel=\"noopener\">Disclaimer<\/a> for the use of this website.<\/p>\n<p><strong>We are a debt relief agency proudly helping Michigan residents exercise their right to file for relief under the United States Bankruptcy Code and the protections it provides.<\/strong><\/p><\/div><\/label><\/div><\/div>        <div class=\"ff-step-t-container ff-inner_submit_container ff-column-container ff_columns_total_2\">\n            <div class=\"ff-t-cell ff-t-column-1\"><div class='step-nav ff_step_nav_last'><button style='float: left;' tabindex='246'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><\/div><\/div>\n            <div class=\"ff-t-cell ff-t-column-2\">\n                <div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" tabindex=\"247\"  aria-label=\"Submit Application Form\">Submit Application Form<\/button><\/div>            <\/div>\n        <\/div>\n        <\/div><\/div><\/div>\n        <\/fieldset><\/form><div id='fluentform_8_errors' class='ff-errors-in-stack ff_form_instance_8_1 ff-form-loading_errors ff_form_instance_8_1_errors'><\/div><\/div>            <script data-jetpack-boost=\"ignore\" type=\"text\/javascript\">\n                window.fluent_form_ff_form_instance_8_1 = {\"id\":\"8\",\"ajaxUrl\":\"https:\\\/\\\/www.jlhaddock.com\\\/wp-admin\\\/admin-ajax.php\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_8_1\",\"form_id_selector\":\"fluentform_8\",\"rules\":{\"names[first_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"names[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"names[last_name]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"email\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"email\":{\"value\":true,\"message\":\"This field must contain a valid email\",\"global\":false,\"global_message\":\"This field must contain a valid email\"}},\"phone\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"valid_phone_number\":{\"value\":true,\"message\":\"Phone number is not valid\",\"global\":false,\"global_message\":\"Phone number is not valid\"}},\"phone_1\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"valid_phone_number\":{\"value\":true,\"message\":\"Phone number is not valid\",\"global\":false,\"global_message\":\"Phone number is not valid\"}},\"address2[address_line_1]\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"address2[address_line_2]\":{\"required\":{\"value\":false,\"message\":\"This 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required\"}},\"dropdown\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"input_radio\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"input_radio_44\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"names_1[first_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"names_1[middle_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"names_1[last_name]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is 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required\",\"global\":false,\"global_message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global\":false,\"global_message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \",\"global\":false,\"global_message\":\"Validation fails for minimum value\"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \",\"global\":false,\"global_message\":\"Validation fails for maximum value\"}},\"input_text_30\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"input_radio_13\":{\"required\":{\"value\":true,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"input_radio_15\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is 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required\"}},\"address4[state]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"address4[zip]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"address4[country]\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"input_text_8\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"input_text_9\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"input_radio_9\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is 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required\"}},\"input_text_25\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"numeric-field_7\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global\":false,\"global_message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \",\"global\":false,\"global_message\":\"Validation fails for minimum value\"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \",\"global\":false,\"global_message\":\"Validation fails for maximum value\"}},\"input_radio_12\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"numeric-field_8\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global\":false,\"global_message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \",\"global\":false,\"global_message\":\"Validation fails for minimum value\"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \",\"global\":false,\"global_message\":\"Validation fails for maximum value\"}},\"input_text_26\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"numeric-field_9\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global\":false,\"global_message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \",\"global\":false,\"global_message\":\"Validation fails for minimum value\"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \",\"global\":false,\"global_message\":\"Validation fails for maximum value\"}},\"input_text_27\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"numeric-field_10\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global\":false,\"global_message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \",\"global\":false,\"global_message\":\"Validation fails for minimum value\"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \",\"global\":false,\"global_message\":\"Validation fails for maximum value\"}},\"input_text_28\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"numeric-field_11\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"},\"numeric\":{\"value\":true,\"message\":\"This field must contain numeric value\",\"global\":false,\"global_message\":\"This field must contain numeric value\"},\"min\":{\"value\":\"\",\"message\":\"Minimum value is \",\"global\":false,\"global_message\":\"Validation fails for minimum value\"},\"max\":{\"value\":\"\",\"message\":\"Maximum value is \",\"global\":false,\"global_message\":\"Validation fails for maximum value\"}},\"input_text_29\":{\"required\":{\"value\":false,\"message\":\"This field is required\",\"global\":false,\"global_message\":\"This field is required\"}},\"numeric-field_12\":{\"required\":{\"value\":false,\"message\":\"This field is 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